electrical injury
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Epidemiology
- 1000 death/year in USA
- 1% of deaths due to trauma
- 60% of fatalities are in males, most commonly age 20-34
- 1/2 of low voltage injuries occur in young children
Pathology
- electrical burns occur due to conversion of energy to heat
- at low voltages alternating current is 3 times more dangerous than direct current
- death many occur due to:
- ventricular fibrillation
- central respiratory arrest
- asphyxia due to tetanic respiratory muscle contractions
- death may occur from as little as 50 volts; conversely individuals may survive shocks of > 100,000 volts
- high voltage shock is associated with more extensive tissue necrosis
- all tissues & organs may be affected by electrical injury
- skin burns are typically full-thickness
- nervous tissue is highly susceptible to injury
- neurologic deficits may be seen initially or up to 3 years later
- spontaneous resolution of early deficits is common
- permanent deficits
- may be delayed days to months
- gradual onset with slow progression
- spinal cord damage is the most common permanent sequella of electrical injury (seldom complete)
- peripheral neuropathies can develop in unburned limbs
- reflex sympathetic dystrophy (RSD)
- causalgia
- cataracts may occur following high-voltage injury
- generally head injury
- usually bilateral
- onset of blurred vision ranges from a few weeks to 3 years
- vascular injury
- smaller vessels unable to dissipate heat are susceptible to thrombosis
- larger vessels are susceptible to mural necrosis & delayed hemorrhage
- vascular injury contributes to high amputation rate from electrical injury
Management
- cardiopulmonary support during acute phase as necessary
- treat as burn injury
- fluid replacement
- burn center referral may be indicated
- silver sulfadiazine has antimicrobial activity
- sulfamylon (a burn cream) may have better tissue penetration
- low voltage injuries
- evolution of tissue injury & vascular necrosis is complete within 7-10 days
- wounds are allow to slough & heal by contracture
- high-voltage injuries
- surgical debridement as needed
- formal amputation & surgical debridement delayed for 2-4 days following injury
More general terms
Additional terms
References
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 2557-58