Electric shock to children

High-voltage electric current causes severe thermal damage, including charring (superficial burns, wounds at the entry and exit points of the current, burn arcs). When exposed to low-voltage current, the development of cardiac arrhythmias, primary and secondary respiratory arrest, impaired consciousness, paresthesia and paralysis come to the fore. Death from electrical trauma occurs due to mechanical asphyxia, cardiac dysfunction, shock, often without external signs of a burn. The peculiarities of clinical death from electrical trauma in children include its extension to 8-10 minutes, which allows for an increase in the effectiveness of cardiopulmonary resuscitation.

When electric current passes through the brain, instant death may occur due to blockade of the centers regulating the functions of vital organs and systems, cardiac arrhythmia, ventricular fibrillation, acute liver failure, laryngospasm, bronchospasm, diaphragm paralysis, respiratory muscle paralysis and acute renal failure may occur. Electric current damage to skeletal muscles and blood vessels is accompanied by severe pain syndrome, renal failure, collapse. Electrical trauma can cause various neurological disorders: general cerebral (coma, seizures) and/or focal disorders (limb paresis, epilepsy), as well as damage to the spinal cord and neuropsychiatric disorders.

An AC shock causes more severe consequences than a DC shock.

There are four degrees of severity of electrical injury:

• In case of electrical injury of the first degree, the child is conscious, excited or stunned. Characteristic are tonic contraction of the muscles of the affected limb, pain in the area of the burn, tachypnea and tachycardia, pale skin.
• At the second degree, severe pain syndrome develops up to shock, consciousness may be absent. Various disturbances of heart rhythm, convulsions and development of respiratory failure are possible. Burns are more extensive and deep.
• Stage III is characterized by the development of coma, heart rhythm disturbances, shock, acute respiratory failure, and laryngospasm.
• At stage IV, clinical death occurs due to ventricular fibrillation.

Emergency medical care for electric shock in children

It is necessary to stop contact with the source of electric current, the wires are removed with wooden, plastic and rubber objects. Then the child is laid horizontally, freeing the chest from clothing.

• In case of clinical death, cardiopulmonary resuscitation is performed, including electrical defibrillation and artificial ventilation. When performing defibrillation in children, a discharge of 4 J per 1 kg of body weight is used.
• In case of mild damage, the child is prescribed sedative treatment and pain relief with analgesics.
• If symptoms of bronchospasm persist, use ipratropium bromide (for children 2-6 years old at a dose of 20 mcg, 6-12 years old - 40 mcg, over 12 years old - 80 mcg), ipratropium bromide + fenoterol (berodual) in a nebulizer (for children under 6 years old - 10 drops, 6-12 years old - 20 drops, over 12 years old - 20-40 drops) or salbutamol (100-200 mcg) in the form of inhalations.
• In case of pain syndrome, a 50% solution of metamizole sodium (analgin) 10 mg/kg, 1-2% solution of trimeperidine (promedol) or omnopon 0.1 ml per year of life are administered.
• In case of convulsive syndrome, it is recommended to administer diazepam (seduxen) 0.3-0.5 mg/kg or midazolam 0.1-0.15 mg/kg intramuscularly, prednisolone - 2-5 mg/kg intravenously, intramuscularly.
• If shock develops, a vein is catheterized, infusion therapy with crystalloids and colloids is administered at a rate of 15-20 ml/(kg h), assisted respiration, vital signs are monitored, and concomitant cardiac arrhythmias are treated.

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