Transcript Electrical Burn

Electrical Burn
Dr. Yasser A. Salem
Lecturer of Anesthesia & ICU
Ain Shams university
Management of electric burns
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Initial Assessment & Management
Airway
Breathing
Circulation
Disability
Expose & Examine
History
Initial Assessment & Management
• Stop the Burning Process
• Neutralize the heat
source
• Remove smoldering
clothing
Airway
• Assess patency of airway
• consider the presence of
smoke inhalation injury
and carbon monoxide
toxicity if smoke is
present
Breathing
• Assess adequacy of breathing efforts (is there
labored breathing, wheezing?)
• Remember that the electrical current can
impair the ability to breathe Initiate
respiratory assistance, if needed
Circulation
• Electrical burn to muscle acts like a crush injury
• Shock from heart damage could be seen within
minutes
• IV line placement and fluid administration
• Cardiac monitoring is indicated with electrical
injury
• CPR and defibrillation per diagnosis and protocol
• Monitor pulse in extremities with contact point
burn or thermal injury; looking for muscle or skin
swelling, impairment to local circulation
(compartment syndrome)
1966 to 2008
120 articles
65 relevant
Circulation
Disability
• Brain and nerve deficits are a common
problem
• Determine status of consciousness and treat
accordingly
• Are all four extremities moving?
Expose & Examine
• Presence of contact point burns
(if present then patient must be
transported to a hospital,
preferably a burn center due to
the risk of the “hidden” injury)
• Assess for presence of arc or flash
burns
• Assess for other traumatic
injuries
History
• Contact time and exposure
• Voltage of electrical injury
• History of other traumatic injury
Components of electric injury
• First component
• The injury caused by the electrical current
itself. The current generates intense heat
often in excess of 2000°F along its path
through the body .
Components of electric injury
• Second component
• The injury from "arcing". Ionization of air particles
associated with a voltage drop is called arcing. The heat
generated in the arc can be as high as 4,000°C and can
vaporize metal. This process frequently causes a patient’s
clothing to ignite and cause flame burns. A form of
explosion dissipates excess energy from the arc.
Components of electric injury
• Third component
• The skin burn caused by a flash. A flash can
result from the power source or from the
ignition of clothing or surroundings.
Components of electric injury
• Fourth component
• Traumatic injury caused by the
intense muscle spasm with the
current or from a fall. There is
also a variety of cardiac, lung
muscle, nerve and internal
organ injuries
Types of electric burns
1-High Voltage Injury
defined as exposure to a
voltage of 1000 volts or
greater (damage beneath
the surface should be
suspected).
Types of electric burns
2-Low Voltage Injury
• Low Voltage is defined as less
than 500 volts (local heat
damage is usually evident e.g. at
the edge of the mouth in kids
biting electric cords)
• Current not sufficient to cause
tissue damage along its course
except at contact site
• Cardiac problems are common
e.g. ventricular fibrillation
Important Note
The term “entrance and exit” sites are commonly used to
describe the damage at a contact point with the
electricity. These terms are really a misnomer when
describing a high voltage AC current injury as the current
is actually passing back and forth between contact with
electricity and grounding site on the body. Low-voltage
injuries usually only have a small burn (or no damage) at
the point of contact.
Injuries caused by high voltage electric burns
1-Injuries along pathway of Current
2-Skin Injury (Contact points)
3-Body Burns
4-Muscle Damage
5-Heart & Blood Vessel Injury
6-Lung Injury
7-Neurologic Injury
8-Orthopedic Injury
1-Injuries along pathway of Current
Ventricular Fibrillation
Other rhythm abnormalities
Respiratory arrest
Seizures/Coma
Mental changes
Hypertension
Retinal detachment
Cataract (delayed)
Muscle necrosis
Fractures
Hemolysis
Renal Failure
Hemorrhage
Limb loss
Anemia
Paresis/paralysis etc.
2-Skin Injury (Contact points)
3-Body Burns
4-Muscle Damage
5-Heart & Blood Vessel Injury
• Immediate cardiac arrest is the most common
cause of death.
• High voltage current has a reported
immediate mortality of 60%.
• The initial heart problems are often reversible
with CPR.
• High blood pressure is also quite common
immediately after injury.
6-Lung Injury
• Impairment of the brain centers stimulation of
breathing and severe central nervous system
damage
• Decreased muscle activity in the chest wall
caused by a chest burn or muscle damage
7-Neurologic Injury
• Acute central nervous system damage with
coma, seizures, motor and, to a lesser extent,
sensory deficits are well described. Many of
these abnormalities are permanent.
8-Orthopedic Injury
Orthopedic injuries occur as a result of three
processes:
• Muscle spasm-induced fractures and
dislocations
• Heat-induced local bone destruction
• Devascularizaton of bone
Injuries caused by law voltage electric burns
• Cardiac Problems
• Muscle Spasm
• Oral Burn
Cardiac Problems
The most severe injury is electrocution as a
household current applied to wet skin is
sufficient to cause ventricular fibrillation and
cardiac arrest (only 60 milliamps is required).
Other rhythm disturbances can also occur.
Muscle Spasm
• Tetany and spasm can also develop with contact with low
voltage. The “can’t let go” current is only 30 milliamps.
• The spasm in the flexor muscles in the hand and forearm
prevents the victim from letting go.
• Suffocation can also occur if the chest muscles go into
spasm as the victim can’t breathe.
• This problem is most commonly seen with immersion in
water like a bath tub.
Oral Burn
• Low-voltage electricity is the
leading cause of electrical injury
in children
• Sucking an extension cord is
responsible for more than half of
the injuries, and biting on an
electric cord accounts for about
30%
• Bleeding from labial artery at the
edge of the mouth is a common
occurrence (20%) during the
period of slough (7 to 21 days)
and should be anticipated.
Pressure control of bleeding will
be necessary.
Case report
A 37-year-old female patient suffered high
voltage electrical injury with resultant exit wound on
the left quadrant of the abdomen measuring 15 × 10
cm2 involving full thickness of the abdominal wall
including the peritoneum. Early debridement and
•J.Y.exploratory
Yang, Y.C.
Tsai,M.S.
laparotomy
was Noordhoff
performed on the fifth
•Department
of Plastic
Surgery, the patient had no abdominal
post-burn
day although
•Chang Gung Memorial Hospital, Taipei, Taiwan 105, Republic of China
symptoms. All visceral organs were grossly normal. The
•Accepted 3 September 1984. Available online 24 May 2005.
peritoneum was closed and the wound covered with
split thickness skin graft. On the twelfth post-burn day
the anterior wall of the stomach sloughed and resulted
in a 10 × 10cm2 gastrocutaneous fistula. After 1 month
of duodenostomy feeding via the fistula using a Foley
catheter, the fistula was closed and was covered with
greater omental flap and split thickness skin.
Seventeen days later the patient was discharged
following an uneventful recovery.
Electrical burn
We report a case of direct electrical injury to the lung
parenchyma, in
without
evidence of any
thoracicawall
contact
Paraplegia
an electrical
burn:
case
report
injury, in an electrician who sustained a 20 kVA.H.N. Roberts
electrical
shock
whileAylesbury,
workingUK
in a substation cubicle. The
Stoke
Mandeville
Hospital,
diagnosis
of a1987.
trueAvailable
electrical
burn
the
left lower lobe was
Accepted
31 July
online
31 of
May
2005.
suggested early on by imaging and then confirmed by
surgical exploration, histological findings and the significant
improvement of the patient’s condition following resection
of thevoltage
infarcted lobe.
All possible
causes
of bronchial
and
A high
electrical
burn
of lung
parenchyma
pulmonary pathologies in such a context were ruled out. The
M.J Masanès, E Gourbière , J Prudent
fatal outcome of two previous similar cases and the
generally
high
mortality
of any
electrical
Accepted
6 March
2000.
Available online
31 July
2000. visceral injury
support early surgical management as the only rational lifesaving treatment. Current pathophysiological knowledge
substantiates the theory of an isolated visceral injury located
far away from the contact wounds. However, the
pathogenesis of such severe injuries is not entirely
understood.
Case report