04.Electrical Burn - pre 3.ppt

7/23/2019 04.Electrical Burn - pre 3.ppt

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ELECTRICALELECTRICAL

BURNSBURNS Dr Ng Siew Weng Dr Ng Siew Weng

Department of Plastic, Reconstructive and Aesthetic Surgery Department of Plastic, Reconstructive and Aesthetic Surgery

Singapore General Hospital Singapore General Hospital



INTRODUCTIONINTRODUCTION

Electrical burns : 1000 deaths / yr in USAElectrical burns : 1000 deaths / yr in USA(of 2 million burn injuries).(of 2 million burn injuries).

Site of accident :Site of accident : or!"lace for most adultsor!"lace for most adults

#ome for children#ome for children

$i%htnin% injury in nature$i%htnin% injury in nature$o& 'olta%e electrical burns : leadin% cause of$o& 'olta%e electrical burns : leadin% cause of

electrical burn injuries in children and adult.electrical burn injuries in children and adult.



EPIDEMIOLOGYEPIDEMIOLOGY

Electricians construction &or!ersElectricians construction &or!ers

hildren :hildren :

*bjects inserted into &all soc!ets e% "ins !eys and fin%ers*bjects inserted into &all soc!ets e% "ins !eys and fin%ers

+ouths :+ouths :

#obbyists in'ol'in% radios com"uters and electrical#obbyists in'ol'in% radios com"uters and electrical

de'ices.de'ices.



Ohm’s LawOhm’s Law

,, ('olta%e)('olta%e) -- (urrent)(urrent) (esistence)(esistence)

#eat is %enerated by electrical current throu%h#eat is %enerated by electrical current throu%ha resistancea resistance

o&ero&er -- 22 (urrent)(urrent) (esistence)(esistence)



FACTORS DETERMININGFACTORS DETERMINING

ELECTRICAL INJURYELECTRICAL INJURY y"e of circuity"e of circuit

esistance of tissuesesistance of tissues

Am"era%eAm"era%e,olta%e,olta%e

urrent "ath&ayurrent "ath&ay

3uration3uration

En'ironmental factorsEn'ironmental factors4. A. oo"er. Emer%ent are of $i%htnin% and Electrical njuries. Seminars in 5eurolo%y ,olume 16 5umber 7 18864. A. oo"er. Emer%ent are of $i%htnin% and Electrical njuries. Seminars in 5eurolo%y ,olume 16 5umber 7 1886



TYPES OF CIRCUIT (DC)TYPES OF CIRCUIT (DC)

3irect current (3) :3irect current (3) : ends to cause a sin%le muscle s"asmends to cause a sin%le muscle s"asm

,ictim can be thro&n from the source,ictim can be thro&n from the source

Shorter duration of e"osureShorter duration of e"osure

ncrease li!elihood of traumatic blunt injury.ncrease li!elihood of traumatic blunt injury.



TYPES OF CIRCUIT (AC)TYPES OF CIRCUIT (AC)

Alternatin% current (A) :Alternatin% current (A) : 7 times more dan%erous than 3 of the same7 times more dan%erous than 3 of the same

'olta%e'olta%e

ontinuous muscle contraction or tetany (90110ontinuous muscle contraction or tetany (90110

#;)#;)

etany occurs e'en at 'ery lo& am"era%es.etany occurs e'en at 'ery lo& am"era%es.

United States : <0 #;.United States : <0 #;. Euro"ean countries : 60 #;.Euro"ean countries : 60 #;.



TISSUE RESISTANCETISSUE RESISTANCE

least resistant (most conducti'e) to mostleast resistant (most conducti'e) to mostresistant (least conducti'e) :resistant (least conducti'e) :

5er'es 5er'es

=lood ,essels=lood ,essels4uscles4uscleset S!in (set S!in (s&eatin%&eatin% resistance)resistance)3ry S!in3ry S!in endonendon >at>at=one=one



CURRENT



VOLTAGE



PATHWAY OF CURRENTPATHWAY OF CURRENT

Etent of tissue dama%e de"ends on "ath&ay of currentEtent of tissue dama%e de"ends on "ath&ay of current

hrou%h the heart or thorahrou%h the heart or thora cardiac arrhythmias andcardiac arrhythmias anddirect myocardial dama%e.direct myocardial dama%e.

hrou%h the brainhrou%h the brain res"iratory arrest sei;ures directres"iratory arrest sei;ures direct brain injury and "aralysis. brain injury and "aralysis.

lose to the eyeslose to the eyes cataracts.cataracts.

4ortality of hi%h 'olta%e burn :4ortality of hi%h 'olta%e burn : #and to hand tra'ersin% chest is <0?#and to hand tra'ersin% chest is <0? #and to >oot 20?#and to >oot 20? >oot to >oot 6?>oot to >oot 6?



MECHANISM OF ELECTRICALMECHANISM OF ELECTRICAL

INJURYINJURY 3irect contact : he Entry/Eit ontact lesion has3irect contact : he Entry/Eit ontact lesion has

three areasthree areas

harred =lac! enter harred =lac! enter

@ray@ray

oa%ulatedoa%ulated 5ecrosis 5ecrosis

artial issue 3ama%eartial issue 3ama%e



Entrance ound: ($eft) Small entrance &ound (dar! s"ot) &ith surroundin%Entrance ound: ($eft) Small entrance &ound (dar! s"ot) &ith surroundin% burn o'er the abdomen. burn o'er the abdomen.

Eit ound: (ri%ht) urrent flo&s throu%h the body from the entrance "ointEit ound: (ri%ht) urrent flo&s throu%h the body from the entrance "ointto the eit "oint in the ri%ht foot.to the eit "oint in the ri%ht foot.




INJURYINJURY

3irect contact3irect contact

Electrical arc :Electrical arc : he most destructi'e indirect injuryhe most destructi'e indirect injury

Eternal "assa%e of hi%h 'olta%e currentEternal "assa%e of hi%h 'olta%e current onised heated "lasma &ith tem"erature 6000 toonised heated "lasma &ith tem"erature 6000 to

2000020000 oo.. Arcs about 1 inch for each 10000 'oltArcs about 1 inch for each 10000 'olt

harred central "ortions of hi%h electrical 'olta%eharred central "ortions of hi%h electrical 'olta%e Seen at entry and eit "ointsSeen at entry and eit "oints burns of clothin% and burns of clothin% andsecondary thermal burns.secondary thermal burns.

Usually not "resent in household 220 'olta%e burns.Usually not "resent in household 220 'olta%e burns.



A! B"#

atient &as near a "o&eratient &as near a "o&er

bo &hich e"loded. bo &hich e"loded.

Electricity arced throu%h theElectricity arced throu%h theair and entered his body.air and entered his body.

he current &as dra&n tohe current &as dra&n to

his arm"its because ofhis arm"its because of

"ers"iration. "ers"iration.




INJURYINJURY 3irect contact3irect contact

Electrical arc :Electrical arc :

>lash burn :>lash burn : su"erficial "artialthic!ness burns.su"erficial "artialthic!ness burns.

hermalhermal




INJURYINJURY 3irect contact3irect contact

Electrical arc :Electrical arc :

>lash burn :>lash burn : hermalhermal

=lunt injury=lunt injury

,ictim thro&n clear of source by intense muscular,ictim thro&n clear of source by intense muscularcontraction orcontraction or fall from a hei%ht.fall from a hei%ht.

A currentA current 'iolent muscle s"asms'iolent muscle s"asms fractures andfractures anddislocations.dislocations.



ORGAN$SPECIFIC DAMAGESORGAN$SPECIFIC DAMAGES

IN ELECTRICAL BURNIN ELECTRICAL BURN



CARDIOVASCULAR EFFECTSCARDIOVASCULAR EFFECTS

Electrical injury may affect the heart in t&o &ays:Electrical injury may affect the heart in t&o &ays: 3irect necrosis of the myocardium3irect necrosis of the myocardium

ardiac dysrhythmias.ardiac dysrhythmias.

5ecrosis in'ol'es : (1) myocardium (2) nodal tissue 5ecrosis in'ol'es : (1) myocardium (2) nodal tissue

(7) conduction "ath&ays and the (9) coronary(7) conduction "ath&ays and the (9) coronary

arteriesarteries

A "roduce %reater dama%e than 3 for any %i'enA "roduce %reater dama%e than 3 for any %i'en'olta%e'olta%e



CARDIAC MANIFESTATIONSCARDIAC MANIFESTATIONS

ardiac standstill and 'entricular fibrillationardiac standstill and 'entricular fibrillation

Sinus tachycardiaSinus tachycardia

5ons"ecific S and &a'e chan%es. 5ons"ecific S and &a'e chan%es.

onduction defects e.%. (1) 'arious de%rees of heart bloc!sonduction defects e.%. (1) 'arious de%rees of heart bloc!s(2) bundlebrunch bloc!s and (7) "rolon%ation of the (2) bundlebrunch bloc!s and (7) "rolon%ation of the inter'al are also common.inter'al are also common.

Su"ra'entricular tachycardias "remature 'entricularSu"ra'entricular tachycardias "remature 'entricularcontractions and atrial fibrillation.contractions and atrial fibrillation.

3e"ression of the ri%ht and left ejection fractions3e"ression of the ri%ht and left ejection fractions

ncrease creatine !inase (B) 4= fractionncrease creatine !inase (B) 4= fraction s"uriouss"uriousdia%nosis of myocardial infarctiondia%nosis of myocardial infarction



CUTANEOUS EFFECTSCUTANEOUS EFFECTS

CCEntry and EitsDEntry and EitsD 4ost common sites of contact for current : hands and s!ull.4ost common sites of contact for current : hands and s!ull. he most common areas of %round (eit): the heels.he most common areas of %round (eit): the heels.

otential for dee"er burns :otential for dee"er burns : 3ee"er burn may occur because of (1) hi%h 'olta%e or (2) moisture on3ee"er burn may occur because of (1) hi%h 'olta%e or (2) moisture onthe s!in &hich lo&ers resistance and allo& transmission of current tothe s!in &hich lo&ers resistance and allo& transmission of current todee"er tissuedee"er tissue ⇒⇒

#eat %enerated by bone#eat %enerated by bone massi'e coa%ulation and necrosis of dee"massi'e coa%ulation and necrosis of dee"muscles and other tissues (almost com"letely s"arin% the s!in)muscles and other tissues (almost com"letely s"arin% the s!in)

Se'erity of the s!in burns cannot be used to assess the de%ree ofSe'erity of the s!in burns cannot be used to assess the de%ree ofinternal injury in an electrical accident &ith lo& 'olta%einternal injury in an electrical accident &ith lo& 'olta%e =SA cutaneous in'ol'ement may not accurately reflect fluid=SA cutaneous in'ol'ement may not accurately reflect fluid

reuirement for resuscitation.reuirement for resuscitation.



CUTANEOUS EFFECTSCUTANEOUS EFFECTS

=urns o'er fleure creases :=urns o'er fleure creases : CCBissin% burnD : occurs at the fleor creases as theBissin% burnD : occurs at the fleor creases as the

electric current arcs causin% arc burns on bothelectric current arcs causin% arc burns on both

fleor surfaces.fleor surfaces. Etensi'e underlyin% tissue dama%e often "resentEtensi'e underlyin% tissue dama%e often "resent

because current became concentrated in its because current became concentrated in its

"assa%e. "assa%e.



CNS EFFECTSCNS EFFECTS

AcuteAcute es"iratory arrest sei;ures mental status chan%eses"iratory arrest sei;ures mental status chan%es

coma amnesia uadri"le%ia and locali;ed "aresis.coma amnesia uadri"le%ia and locali;ed "aresis.

urrent throu%h s!ullurrent throu%h s!ull coa%ulation of braincoa%ulation of brain "arenchyma e"idural and subdural hematomas and "arenchyma e"idural and subdural hematomas andintra'entricular haemorrha%es.intra'entricular haemorrha%es.

eri"heral neuro"athyeri"heral neuro"athy

$ate$ate Ascendin% "aralysis trans'erse myelitis amyotro"hicAscendin% "aralysis trans'erse myelitis amyotro"hic

lateral sclerosislateral sclerosis



EFFECTS ON E%TREMITIESEFFECTS ON E%TREMITIES

EXTREMITIES :EXTREMITIES :

>racture / dislocations includin% s"inal injury>racture / dislocations includin% s"inal injury om"artment syndrome :om"artment syndrome :

$oss of intra'ascular fluid F nelastic fascial$oss of intra'ascular fluid F nelastic fascialcom"artmentscom"artments

interstitial "ressure Ginterstitial "ressure G ca"illary "erfusionca"illary "erfusion "ressure "ressure "erfusion G hy"oia G "erfusion G hy"oia G etra'asationetra'asationGG interstitial "ressure of com"artment.interstitial "ressure of com"artment.

otentialSi%ns "ain "allor "aresis andotentialSi%ns "ain "allor "aresis and "ulselessness "ulselessness

e'ersible before < hrs.e'ersible before < hrs.



Electric burn &hile holdin%Electric burn &hile holdin%

a tool. he entrance &ounda tool. he entrance &ound

&ith thermal &ound sho&n.&ith thermal &ound sho&n.

Same hand a fe& days laterSame hand a fe& days later

&ith dee"er tissue&ith dee"er tissue

in'ol'ement.in'ol'ement.



OPHTHALMIC EFFECTSOPHTHALMIC EFFECTS

ataracts :ataracts : #ead H cec! electrical injuries#ead H cec! electrical injuries

I 1000 'oltsI 1000 'olts

9 to < months after accident9 to < months after accident

*ther effects : corneal lesions u'eitis*ther effects : corneal lesions u'eitis

iridocyclitis 'itreous hemorrha%e o"ticiridocyclitis 'itreous hemorrha%e o"tic

atro"hy retinal detach and chorioretinitisatro"hy retinal detach and chorioretinitis



OTHER ORGAN EFFECTSOTHER ORGAN EFFECTS

RENALRENAL :: Similar to crush injuriesF myo%lobinuriaSimilar to crush injuriesF myo%lobinuria

4yo%lobin4yo%lobin acute renal failureacute renal failure

VASCULAR INJURYVASCULAR INJURY ::

3irect result of current flo&3irect result of current flo& Secondary due to surroundin% tissue dama%eSecondary due to surroundin% tissue dama%e



OTHER ORGAN EFFECTSOTHER ORGAN EFFECTS

Ear Effects :Ear Effects : y"anic membrane ru"ture freuently found iny"anic membrane ru"ture freuently found in

li%htnin% "atients andli%htnin% "atients and

3isru"tion of the ossicles may occur3isru"tion of the ossicles may occur

erebros"inal fluid otorrhea hematym"anic anderebros"inal fluid otorrhea hematym"anic and

"ermanent deafness. "ermanent deafness.



E&'!!a& B"# Ma#a*'m'#E&'!!a& B"# Ma#a*'m'#

4a!e sure current is off 4a!e sure current is off $i%htnin% ha;ards$i%htnin% ha;ards

3o not %o near "atient until current is off 3o not %o near "atient until current is off

A=JsA=Js ,entilate and "erform as needed,entilate and "erform as needed

*y%en*y%en E@ monitorin%E@ monitorin%

reat dysrhythmiasreat dysrhythmias



Ma#a*'m'#Ma#a*'m'#



MANAGEMENTMANAGEMENT

S"ecifically for "atients admitted to U :S"ecifically for "atients admitted to U : horou%h e'aluation for hidden injury (es"ecially s"inal cordhorou%h e'aluation for hidden injury (es"ecially s"inal cord

injury) and for blunt thoracic or abdominal trauma.injury) and for blunt thoracic or abdominal trauma. Serial e'aluation of li'er "ancreatic and renal function forSerial e'aluation of li'er "ancreatic and renal function for

traumatic and anoic/ischemic injury (in case oftraumatic and anoic/ischemic injury (in case ofcardiores"iratory arrest)cardiores"iratory arrest)

A""ro"riate ima%in% studies (e.%. com"uted tomo%ra"hy orA""ro"riate ima%in% studies (e.%. com"uted tomo%ra"hy orabdominal sono%ram) as necessary.abdominal sono%ram) as necessary.

scan of the head is indicated in all se'ere cases of li%htnin% scan of the head is indicated in all se'ere cases of li%htnin%injury of injuries due to a fall and if there are "ersistentinjury of injuries due to a fall and if there are "ersistent

abnormal findin%s in the neurolo%ic eamination.abnormal findin%s in the neurolo%ic eamination. re'enti'e treatment for stress ulcers.re'enti'e treatment for stress ulcers. sychiatric assessment and su""ort as soon as the "atient issychiatric assessment and su""ort as soon as the "atient is

conscious and hemodynamically stable.conscious and hemodynamically stable.



MANAGEMENTMANAGEMENT

atients &ith hi%h'olta%e :atients &ith hi%h'olta%e : E'aluation for rhabdomyolysis and myo%lobinuriaE'aluation for rhabdomyolysis and myo%lobinuria

(uncommon in li%htnin% injury).(uncommon in li%htnin% injury).

E'aluation of the limbs for com"artment syndromeE'aluation of the limbs for com"artment syndrome

may reuire fasciotomy (rare in li%htnin% injury). may reuire fasciotomy (rare in li%htnin% injury).

5utritional su""ort due to increased ener%y 5utritional su""ort due to increased ener%y

e"enditures.e"enditures. *"hthalmolo%ic and otosco"ic e'aluation*"hthalmolo%ic and otosco"ic e'aluation

(common in cases of li%htnin% injury).(common in cases of li%htnin% injury).



PREVENTIONPREVENTION

#ome and &or!"lace :#ome and &or!"lace : #ouseholds electrical cords &all soc!ets#ouseholds electrical cords &all soc!ets

etension cordsetension cords

E"osed hi%h tensions electrical installationE"osed hi%h tensions electrical installation























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04.Electrical Burn - pre 3.ppt