Electrical burns

Author: Made Ananda Krisna, General Practitioner, Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas, Indonesia; Chief Editor: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, September 2015.

What are electrical burns?

Burns are a form of tissue injury that is caused following a contact with heat, flame, chemicals, electricity, or radiation. When electricity has caused the burn, it is known as an electrical burn.1

Who gets electrical burn?

Anyone who has contact with electrical current can get an electrical burn. Typically, an electrical injury/burn patient is a working, healthy, young man at home or in the workplace.2,3,4

What causes electrical burn?

Electricity is defined as a flow of electrons. Electrons flow when there is a difference of electrical potential between by two points (voltage). The higher the voltage, the higher the current of electrons (the Law of Ohm).

Electrical burn is classically divided by 2 groups:

How much skin damage is experienced depends on:2

What are the clinical features of electrical burns?

Electrical injury results in tissue/organ damages through 3 different pathways:2

Low voltage electrical burn

Low voltage electric current leads to 2 well-circumscribed electrothermal burns:2,6

  1. Contact burn at entry site (eg hands, skull)
  2. Exit wound (eg heels in contact with the ground)

They may be deep partial-thickness or full-thickness burns.6

High voltage electrical burn

High voltage injury may be due to direct contact or flashing.

A electric arc or spark, including a lightening strike, is produced between a highly-charged source and the ground, reaching temperatures of up to 2500C.5

A kissing burn is an electric arc generated between two skin surfaces facing each other and sandwiching a joint, typically the elbow and knee flexures. The arc crosses the flexor crease and burns the two “kissing” skin surfaces causing vast underlying tissue destruction. 2,5

Cutaneous involvement alone may underestimate the extent of underlying tissue damage. 2,5,7

How are electrical burns diagnosed?

Preceding electrical exposure confirms the diagnosis.

In an unconscious patient in an appropriate environmental setting:

Skin

Heart

Respiratory system

Vascular*

Neurologic*

Musculoskeletal*#

Kidney

Other

Note:

Calculating total body surface area

There are several ways to determine the TBSA:7

Electrocardiography

Electrocardiography (ECG) should be conducted in every electrical burn case. Continuous cardiac monitoring is required if there is documented arrhythmia and/or signs of ischaemia, history of loss of consciousness, or suspected high voltage electrical injury.2

Other tests

Complete blood count, electrolytes, blood urea nitrogen, and creatinine are ordered for patients with substantial injuries or if there is risk for conductive electrical injuries (presence of entry and exit wounds or rhythm abnormalities).2

Urinalysis to detect positive presence of blood without red blood cells can identify myoglobinuria due to muscle destruction. 2

Creatinine kinase level should be measured in high voltage injuries because its peak concentration predicts extent of muscle injury, amputation risk, mortality, and length of stay.2

What is the treatment for electrical burns?

Pre-hospital setting

In the pre-hospital setting, priorities are to:

Management of electrical burn wounds

Management of electric burn wounds should include:7

  1. Cleansing: debride loose tissue and blister remnants
  2. Moisturise to promote early epithelisation
  3. Apply broad spectrum antimicrobial agent

Options include:

Surgical management

Early decompression procedure is required for contracted and tight compartment of extremity (eg forearm, leg) based on a peripheral neurovascular evaluation.

Surgical debridement of unhealthy tissue followed with definitive wound closure is done at day 3 to 5 once the injured tissue is well demarcated.

Excision and grafting may be required for contractures a few weeks following deep partial thickness and full thickness burns.

What is the outcome for electrical burn wounds?

Deep partial-thickness or full-thickness wounds inevitably cause scarring. Other potential long-term complications of electrical wounds include:

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