Electrical injuries present with a wide spectrum of damage, from superficial skin burns to multisystem injury. Electrical injuries are arbitrarily classified as low voltage (≤1000 V) and high voltage (>1000 V). At very high voltages, an electric arc may also travel from a voltage source to a person and cause severe burns. Standard household electricity is low voltage alternating current (AC), power lines are high voltage. Young children most often sustain low voltage injuries in the home from electrical outlets or chewing on electrical wires, whereas adults more often sustain high voltage injuries while at work.
Electrical injuries cause injury via several mechanisms: direct tissue damage from electrical energy, thermal damage from heat created by tissue resistance, and mechanical injury induced by a fall or tetanic muscle contraction. Severity of injury and tissues affected depend on voltage, duration of contact, tissue resistance, and path of current. The risk for serious injury increases with as voltage increases. Patients may sustain immediate cardiac dysrthymias (including ventricular fibrillation), respiratory arrest or seizures. Cardiac complications, such as arrhythmias and QT prolongation are more commonly seen in high voltage injuries. Temporary loss of consciousness is common. Severe burns may results from contact with high voltage lines. Entrance and exit burns are typically painless, gray to yellow depressed areas. The size of the skin injury does not correlate well with internal injuries. Traumatic injuries frequently accompany electrical injuries. Details of specific immediate and delayed systemic injuries and complications are summarized in Table 126-1.
Table 126-1 Immediate and Delayed Complications of Electrical Injuries |Favorite Table|Download (.pdf)
Table 126-1 Immediate and Delayed Complications of Electrical Injuries
|Cardiovascular||Sudden death (ventricular fibrillation, asystole), chest pain, dysrhythmias, ST-T segment abnormalities, bundle branch block, myocardial damage, myocardial infarction (rare), hypotension (volume depletion), hypertension (catecholamine release)|
|Neurologic||Altered mental status, agitation, coma, seizures, cerebral edema, hypoxic encephalopathy, headache, aphasia, weakness, paraplegia, quadriplegia, spinal cord dysfunction (may be delayed), peripheral neuropathy, cognitive impairment, insomnia, emotional lability|
|Cutaneous||Electrothermal contact injuries, noncontact arc and “flash” burns, secondary thermal burns (clothing ignition, heating of metal)|
|Vascular||Thrombosis, coagulation necrosis, disseminated intravascular coagulation, delayed vessel rupture, aneurysm, compartment syndrome|
|Pulmonary||Respiratory arrest (central or peripheral, eg, muscular tetany), aspiration pneumonia, pulmonary edema, pulmonary contusion, inhalation injury|
|Renal/metabolic||Acute renal failure (due to heme pigment deposition and hypovolemia), myoglobinuria, metabolic (lactic) acidosis, hypokalemia, hypocalcemia, hyperglycemia|
|Gastrointestinal||Perforation, stress ulcer (Curling ulcer), GI bleeding, GI tract dysfunction, various reports of lethal injuries at autopsy|
|Muscular||Myonecrosis, compartment syndrome|
|Skeletal||Vertebral compression fractures, long bone fractures, shoulder dislocations (anterior and posterior), scapular fractures|
|Ophthalmologic||Corneal burns, delayed cataracts, intraocular hemorrhage or thrombosis, uveitis, retinal detachment, orbital fracture|
|Auditory||Hearing loss, tinnitus, tympanic membrane perforation (rare), delayed mastoiditis or meningitis|
|Oral burns||Delayed labial artery hemorrhage, scarring and facial deformity, delayed speech development, impaired mandibular/dentition development|
|Obstetric||Spontaneous abortion, fetal death|
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