What is Electrical Injuries?
Electrical injuries are quite common and can be serious. They can happen from lightning strikes, or from exposure to low or high voltage electricity. Most of the time, these injuries are accidental and can be prevented. If the damage from these injuries doesn’t cause immediate death, it can harm various parts of the body.
Here are the four main types of electrical injuries: flash, flame, lightning, and what we call ‘true’ electrical injuries. Flash injuries happen when an arc flash, resulting from an electrical discharge, causes burns on the surface of the skin without the electrical current going deeper than that. Flame injuries occur when an arc flash sets a person’s clothing on fire; in these instances, the electrical current could either stay on the surface of the skin or go deeper.
Lightning injuries are caused by quick but powerful lightning strikes, where the electrical current travels through the entire body. ‘True’ electrical injuries happen when a person essentially becomes a component of an electrical circuit, with clear entry and exit points for the electrical current on their body.
What Causes Electrical Injuries?
People might experience an electrical injury in their homes from things like small appliances, extension cords, or wall sockets. Luckily, these incidents rarely come with serious trauma or complications. Children can get low-voltage injuries, without losing consciousness or having a heart stoppage, by biting or chewing on an electrical cord. Adults can get similar injuries while fixing home or office appliances or circuits. Low-voltage electrical currents can cause as severe injuries as high-voltage currents. The severity of the injury depends on how long someone was exposed to the current, the person’s size, and how much of their body was in contact with the electricity.
In workplaces, more than half of all electrocutions happen because of contact with power lines. About a quarter of the time they are caused by electrical machines or tools.
Risk Factors and Frequency for Electrical Injuries
In the US, around 1000 people die each year from electric injuries. Among these fatalities, around 400 are because of high-voltage electric injuries while lightning strikes result in 50 to 300 deaths. In addition to this, there are also roughly 30,000 non-deadly shock incidents each year.
About 5% of annual admissions to burn units in the US are a result of electrical injuries. Children represent around 20% of all people who suffer from electrical injuries, with toddlers and adolescents being the most affected. In terms of adults, these injuries are most common in the workplace, making it the fourth leading cause of traumatic death at work. On the other hand, for children, most electrical injuries occur at home.
Signs and Symptoms of Electrical Injuries
Electrical injuries can cause a range of different health issues. Some people might have heart or breathing problems, fall into a coma, suffer physical injuries, or get different types of burns. Some people might just feel a bit unwell, while others could have severe pain and visible tissue damage. Understanding the source of the electrical injury, such as whether it was high or low voltage, is crucial. This information can inform about the gravity of the situation and the next steps to take.
Low-voltage electrical injuries usually result in skin burns. However, if the contact was prolonged or if the muscles contracted tightly, the injuries could be devastating. These injuries could cause heart or respiratory problems, arrhythmias (abnormal heart rhythms), or even seizures. Therefore, it’s important to consider the possibility of electrocution if someone has recently had a cardiac or respiratory arrest. Gathering as much information as possible from any witnesses or emergency responders can be quite valuable in these cases.
High-voltage injuries, on the other hand, typically cause severe burns. Losing consciousness or experiencing a cardiac arrest from this type of injury is pretty rare. Again, getting as much information as possible about the injury will be helpful.
Regardless of the type or severity of the electrical injury, all patients should be thoroughly examined to determine the full extent of the damage. Generally, low-voltage injuries tend to have more severe complications than high-voltage injuries.
Abnormal heartbeat can happen after exposure to voltage as low as 50 to 120 mA, which is below what most households use. Aside from this, electrical injuries can directly damage the heart cells, which could lead to delayed arrhythmias like sinus tachycardia or premature ventricular contractions. However, long-term heart effects from electrical injuries are uncommon.
If the electrical current passes through the chest, the chest wall muscles can become paralysed and cause respiratory arrest. But fortunately, lung tissues are poor conductors of electricity, so direct electrical injuries to the lungs are rare.
Besides heart complications, skin damage is the most severe injury associated with electrical injuries. Burns might seem minor on the surface, but they often conceal significant internal injuries, especially with high-voltage burns. Such injuries might require surgical procedures like amputation or fasciotomy. Severity of the burns often depends on how intense the contact was and for how long it lasted.
An electrical arc is another form of electrical injury. It’s created when an electrical current travels between two electrodes, ionizing the gases in the air. It’s how lightning happens in nature, but it can also be harnessed for industrial purposes like welding, plasma cutting, or fluorescent lighting. If improperly handled, it could lead to burns at the points of contact. These burns usually have a dry parchment-like center surrounded by a congested rim. This type of injury can also lead to electrothermal, flash, or flame burns.
Flash burns happen when a person is near enough to feel the heat from an electrical arc, which can reach temperatures over 50,000 degrees Celsius. Depending on the path of the arc, these burns can either pass through the body like an arc burn or just graze the skin surface, causing widespread superficial or partial-thickness burns without any internal damage.
In pediatric cases, children may experience oral burns if they bite or suck on an electrical wire or appliance. An electrical arc can form between both sides of the mouth, possibly resulting in muscle damage or lip deformation. There may be significant swelling and the formation of an eschar (a piece of dead tissue) within a few days. If it involves a large artery, then severe bleeding can occur when the eschar falls off after a couple of weeks. Therefore, regular follow-ups with burn, oral, or plastic surgery specialists are essential for these patients.
Electrical injuries can also cause other physical injuries, especially if they result in falls or violent muscle contractions. This may lead to musculoskeletal or head damages, which can impact hearing, neck mobility or facial structure and cause potential subsequent neurological damage. Early consulting a surgeon could avoid further complications, such as compartment syndrome, a severe condition that could necessitate amputation.
Testing for Electrical Injuries
People who have experienced electrical injuries should be medically examined for both physical injuries and possible heart issues. For adults, doctors usually perform a heart activity test, called an electrocardiogram (ECG), to monitor heart health. Heart monitoring for an extended period may be needed if the patient complains about chest pain, has an abnormal ECG result, indicates the electrical shock passed through his/her chest (transthoracic path of injury), has experienced a cardiac arrest or loss of consciousness, or has a known history of heart problems. In most cases, if there aren’t any significant injuries or heart concerns within 24 to 48 hours of the electrical shock, it is unlikely that heart troubles will develop later on.
In general, if a person who has had a low-voltage electrical injury has normal ECG results, no complaints about heart problems, or no past heart issues, they can be sent safely home. The same applies to children who have been exposed to low-voltage household current without any considerable injury or previous heart issues. They can safely be sent home after a thorough examination.
There are a few key lab tests that should be carried out if anyone experiences an electrical injury. These include a complete blood count (to check the cells in your blood), a complete metabolic panel (to measure certain chemicals in your blood), and urinalysis (to test urine for various cells and chemicals). Based on the urinalysis, a serum myoglobin test may be required (to check for muscle tissue breakdown). People with rhabdomyolysis (a condition marked by muscle breakdown that can lead to kidney damage) or those who need respiratory assistance may also require an arterial blood gas analysis (a blood test that measures oxygen and carbon dioxide levels). Creatine kinase, an enzyme that may increase after heart attacks or other muscle damage, needs to be checked particularly if rhabdomyolysis is suspected. If electrical current has passed through the chest, or if the patient complains of chest pain, Creatine kinase-MB, which is a type of creatine kinase, and troponin levels (markers that indicate heart muscle damage) should be measured.
Images of the body, like X-rays or scans, may also be helpful in diagnosis. If a patient complains of chest pain, shortness of breath, has an oxygen deficiency, or required cardiopulmonary resuscitation (CPR) which is an emergency procedure for heart or lung failure, a chest X-ray is advised. A head CT scan, a special X-ray test that produces cross-sectional images of the brain, is generally required for patients who show mental status changes, had an impact on the head, lost consciousness, or show any focal neurologic deficits such as problems with nerves, spinal cord, or brain functions. Special precautions should be taken during these tests like immobilizing the neck to reduce the risk of spinal cord injuries.
It is crucial to remember that the harm caused by an electrical injury may not correspond to the visible burns on an individual’s body. This means an absence of visible burns does not rule out electrical injury to the body’s internal organs. Therefore, additional scans such as CT or ultrasound may be required to assess any internal injuries based on the electrical current’s path through the body, with the selection of scan type depending on the tissue being examined.
Last but not the least, exposure to high-voltage electricity or prolonged exposure to low-voltage electricity can result in tissue damage severe enough to demand a surgical procedure called fasciotomy. Surgeons should be consulted straightaway in these cases. Timely fasciotomy can help avoid severe complications such as amputation.
Treatment Options for Electrical Injuries
When someone comes to the emergency room due to an electrical injury, the healthcare team immediately focuses on stabilizing their condition. They start by ensuring the patient is breathing properly and their blood circulation is in order. This approach is instructed by advanced protocols that healthcare teams follow in such emergencies. If the injury is more than a minor electric shock, the patient’s heart activity is closely monitored.
People with facial or oral burns, difficulty breathing, loss of consciousness, or other issues making it hard to breathe may receive oxygen and help keeping their airways open. This help can come in the form of a breathing machine, tube insertion into their airways, or an emergency procedure to create an artificial airway.
Depending on the nature of the injury, measures might be taken to protect the patient’s neck or spine. The healthcare team quickly checks for any traumatic injuries such as collapsed lungs or broken bones. If the patient has severe burns or a condition leading to extreme muscle damage (known as rhabdomyolysis), they receive fluids to improve hydration. In some cases, they might also need medication to enhance urine flow and remove toxins from the body.
The team will insert an intravenous (IV) line to deliver treatments directly into the bloodstream. If the injury has led to serious trauma, if the heart or breathing has stopped, or if the patient loses consciousness, a central IV line may be inserted, which can deliver treatments more rapidly.
The team will also start proper burn care, which may include a tetanus shot, and properly bandaging the area after checking for nerve or blood vessel damage.
If the patient had a cardiac or respiratory arrest, loss of consciousness, chest pain, low oxygen levels, abnormal heart rhythm, significant injuries or burns, or abnormal electrical activity in the heart (detected by ECG), they will be admitted to the hospital for further care. This could entail transfer to a specialized burn or rehabilitation center.
Finally, to avoid any complications or irreversible damage, the healthcare team will seek the guidance of trauma, critical care, surgery, and orthopedics specialists as needed.
Before the patient leaves the hospital, the team will educate them about possible sources of electrical exposure at home or work, as well as potential long-term effects of their injuries, which can include neurological, psychological, or physical impacts. They will also schedule follow-up visits as necessary.
What else can Electrical Injuries be?
When it comes to diagnosing electrical burns, there are several other conditions that could be mistaken for it. These might include:
- Chemical burns
- Thermal burns
- Bleeding within the skull, also known as Intracranial haemorrhage
- Eye burns and chemical injuries
- Sudden stopping of breathing, known as Respiratory arrest
- A condition where muscle tissue breaks down, known as Rhabdomyolysis
- Seizures
- Fainting, or Syncope
- Continuous seizures, or Status epilepticus
- An irregular heart rhythm, known as Ventricular fibrillation
What to expect with Electrical Injuries
The location and extent of an injury, along with any complications and how well a person can function afterwards, all play a part in how well a person recovers and what the future may hold for them. High voltage electrical injuries generally have worse outcomes compared to low voltage ones. However, thanks to advancements in intensive care, ways of bringing someone back to health, nutritional support and surgical techniques, along with new alternatives to skin grafts, the outcomes for patients have seen significant improvement.
Possible Complications When Diagnosed with Electrical Injuries
High electric field strength can cause considerable damage to the body. It can cause protein hardening, tissues dying due to an inability for blood to clot, blood cell destruction, blood clotting, muscle or tendon injuries, or loss of body water. In addition to this, the high electric field strength can also lead to a lot of swelling in the tissues. This swelling can be caused by blood clotting, blood getting trapped in certain areas, and muscle swelling due to the injury.
Such excess swelling can cause compartment syndrome, a dangerous condition where pressure within a muscle compartment exceeds the blood supply, leading to muscle and nerve damage. The swelling can also lead to dehydration. This, in turn, can cause low blood volume and low blood pressure. Severe muscle damage due to electric field strength can also lead to rhabdomyolysis (a breakdown of damaged skeletal muscle), myoglobin in urine, and imbalance of electrolytes in the body. All these changes can greatly increase the risk of sudden kidney damage.
High electric field exposure can also have long-term effects that include:
- Neurological: Nerve damage, seizures, fainting, ringing in the ears, numbness or tingling sensation, weakness, loss of balance, or unsteady walking
- Psychological: Difficulties with memory or attention, irritability, depression, post-traumatic stress disorder
- Ocular: Development of cataracts
- Physical: Pain, fatigue, muscle hardening, muscle contractions, itching, headaches, fever or night sweats, loss of flexibility or stiffness in the joints
Preventing Electrical Injuries
To avoid getting an electrical burn in your home, it’s a great idea to take some safety measures. These include putting child-safety covers on all electrical outlets and making sure electrical cords are kept away from children. Always follow the instructions when using electrical appliances and try to avoid using them in the shower or bath. If you’re doing work involving electricity, remember to turn off the circuit breaker first.
Before you leave the hospital, your doctor will talk to you about possible sources of electrical hazards at home and work. They’ll also discuss any potential long-term health effects from your electrical injury. These could include problems with your nerves (neurological), mind (psychological), or body (physical). Your doctor will also schedule follow-up appointments as necessary to make sure you’re healing well.
