Medical expert of the article
New publications
Electric trauma
Last reviewed: 23.04.2024
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Electrical injury is a trauma caused by exposure to organs and tissues of an electric current of great strength or tension (including lightning); characterized by the defeat of the nervous system (convulsions, loss of consciousness), circulatory and (or) breathing disorders, deep burns.
Electric burn - a burn caused by the passage through the tissue of an electric current of considerable strength and tension; characterized by a large depth of damage.
Code for micro-10
- T75.4 Effect of electric current.
- W85 Accident associated with power line.
- W86 Accident associated with another refined source of electric current.
- W87 Accident attributable to the source of the electrical current, unspecified.
- ХЗЗ Victim of a lightning strike.
Epidemiology
Electrical injuries occur in 1-2.5% of all types of injuries. The most common electrical injury is observed in people working with devices and installations that are under voltage. According to international statistics, electric injury accounts for 0.2% of all occupational accidents, and lethal lesions from it - 2-3%, which significantly exceeds the mortality from other types of injuries.
What causes electrical injury?
The etiological factor of electric trauma and electric burns is the electric current of various stresses and forces.
How does electric injury develop?
Electrical injury is a special type of thermal damage. A specific effect is the electrochemical, thermal and mechanical effects. Electrochemical involves electrolysis, which results in the ionic equilibrium being broken in the cells and the biological potential is changing. Redistribution of negatively and positively charged ions significantly changes the functional state of the cells and causes the formation in some areas of coagulation, and in others - collisional necrosis. Thermal action of electric current leads to a burn of skin and deeper tissues down to charring. As a result of the mechanical action of the current, lamination and rupture of soft tissues are observed, less often the separation of body parts.
The non-specific effect of electric current is due to other types of energy. In particular, from a voltaic arc (temperature up to 40 000 ° C) thermal burns of the skin and eyes occur. The result of a fall from a height with an electric shock may be dislocations of joints, fractures of bones, damage to internal organs. Spasmodic contractions of the muscles can lead to detachable fractures of the bones. If clothing affected by the current is inflamed, electric trauma can be combined with severe skin burns. . To factors aggravating the degree of electric shock, include increased humidity, overheating, exhaustion, chronic diseases, alcohol intoxication.
Electric current causes local and general changes in the body of the victim. The severity of the lesion depends on the parameters of the electric current, the ways of its spread in the body, the nature of damage to organs and tissues, the general condition of the victim. Death can sometimes occur immediately after an injury (2-3 minutes) from the paralysis of the vital structures of the medulla oblongata. When the current passes through the upper loop (hand-arm), the lethal outcome comes from cardiac arrest as a result of damage to the myocardium.
Often, the victims are observed the state of "imaginary death" - a deep depression of the central nervous system, which leads to inhibition of the centers of the cardiovascular and respiratory systems as a result of the action of a high-voltage current or, under certain conditions, a small voltage (220 V). In such a situation, the cause of "imaginary death" is considered oppression of the functions of the medulla oblongata, fibrillation of the ventricles of the heart and tetanic spasm of the respiratory muscles.
The peculiarity of contact electric burns is local deep tissue damage with minimal skin burn, and the necrosis zone is larger when vessels are involved along the current flow path due to their thrombosis. When the major arteries of the extremities defeat gangrene, the possibility of thromboembolism of the vessels of the lungs and brain is not ruled out.
The course of the wound process with electric burns is subject to general laws and includes inflammation, suppuration, rejection of dead tissue, formation of granulations, scarring. Unlike thermal burns, the terms of rejection of necrosis - up to 6-7 weeks, are significantly more often complications (phlegmon, arthritis, lymphadenitis, lymphangitis).
Symptoms of electrical injury
During electrotrauma, various pathological processes occur in the victim's body. First of all, it concerns the central nervous system: there may be a loss of consciousness, often motor and speech excitement, increase or decrease of tendon and skin reflexes. Changes in the cardiovascular system are characterized by an increase or decrease in blood pressure, atrial fibrillation, and ventricular fibrillation. Usually these changes are found at the time of injury or in the next few hours after it, sometimes they persist for a longer time.
In the acute period, often there is a widespread spasm of blood vessels and an increase in the total peripheral resistance, which is accompanied by cold extremities, cyanosis, and decreased sensitivity. Observe also thrombosis of the arteries, leading to the defeat of muscles in places of passage of electric current. This pathology is sometimes difficult to diagnose, because the skin over them almost always remain unchanged. For early diagnosis, angiography and scintigraphy, diagnostic necrotic incisions are used. Subsequently, the affected muscle tissue undergoes purulent melting, which is accompanied by severe intoxication, development of sepsis, arthritis.
Electric current also affects internal organs: nerve necrosis can be observed in the gastrointestinal tract, liver, lungs, pancreas, which is caused by circulatory disorders. Diagnosis is difficult due to fuzzy and mild symptoms. If the place of electric current is a head, visual disturbances can be observed (corneal damage, retinal detachment, optic neuritis, glaucoma) and hearing.
When passing a current of small force (up to 10 mA), pain can occur in the place of contact with a current-carrying object, a feeling of "runniness"; at a stronger current (up to 15 mA), the pain extends over the whole area of contact, there is an involuntary contraction of the muscles, the victim can not independently tear himself away from the electrical wire. Under the influence of a current of 50 mA or more, involuntary contractions of the chest muscles, loss of consciousness, weakening of the heart activity, respiratory depression, up to "imaginary death" are observed. Currents of 0.1 A are very dangerous, and 0.5 A are deadly to humans.
How is electric trauma recognized?
Local changes in electrical burns can be of the contact type - in places of entry, exit and along the path of current propagation; Possible damage from the flame of a voltaic arc or burning clothing. "Current tags" are more often located on the upper limbs, they can be round in shape from a few millimeters to 2-3 cm in diameter, sometimes they look like a cut wound, abrasions, and pinpoint hemorrhage. Possible and mixed lesions: a combination with a burn flame voltaic arc or with a mechanical trauma.
More often the electric injury is represented by a white or black wail. Sometimes, with a burn of 6,000-10,000 V, torn dark shades of muscle appear in the wound. Rapidly swelling of soft tissues, which in no small measure contributes to an increase in the permeability of the vascular wall.
Electrical trauma is often accompanied by damage to the bones of the cranial vault due to the insignificant thickness of the soft tissues. At the burn site, a dense, immobile scab of dark color is formed, often areas of charred bone are exposed. When the skull is burned, the brain structures can be damaged, which is confirmed by the data of clinical and instrumental (encephalography, CT) examinations. Also, the development of paresis, visual and auditory disorders is not ruled out. In the long-term period, this category of patients may develop purulent intracranial complications - meningitis, menin-goencephalitis, abscesses.
In burns with flames of the voltaic arc, unlike electric burns, open areas of the body (face, hands) almost always suffer. Damage is always superficial and heals within 5-10 days.
Laboratory research
During electrotrauma qualitative and quantitative composition of blood elements changes: phagocytic activity of leukocytes steadily decreases, erythrocytopenia develops due to the increase in the rate of cell decay. On the part of biochemical indicators, the level of residual nitrogen, glucose, bilirubin often increases, the albumin-globulin coefficient decreases, and abnormalities on the part of the coagulating system of blood are possible.
Differential diagnostics
In the early period after the injury, it is sometimes difficult to make a differential diagnosis between an electric burn and a deep flame burn caused by the burning of clothing in a combined trauma. In these cases, the cause of the lesion is clarified during the treatment at a later date.
[11], [12], [13], [14], [15], [16]
Indications for consultation of other specialists
In a hospital, patients with electric trauma need to be monitored by various specialists (therapist, neurologist, psychiatrist) in the intensive care unit or intensive care unit.
Example of the formulation of the diagnosis
Electrical injury. Electric burn of III-IV degree of left hand 3% of body surface. Burns flame I-II degree of the face and right hand 5% of the body surface.
Treatment of electric trauma
General treatment of electrotrauma is aimed at normalizing the functions of internal organs and body systems, preventing and treating infectious complications.
Indications for hospitalization
All victims with electric shock are subject to hospitalization, which may be indicated by loss of consciousness, presence of current marks or more extensive burns.
Non-pharmacological treatment of electrotrauma
It is important to know the principles of first aid in case of electric shock. The use of relatively simple measures can often save the life of the victim and prevent injuries to the persons who assist him. In the first place, the effect on the affected electric current should be discontinued. When a low-voltage current is applied (no more than 380 V), switch off the circuit breaker or remove the fuses on the switchboard. You can flush a wire with a dry stick from the victim or cut the wire with an ax. Approaching the victim is not dangerous. When the limb is "fixed" to the current carrying wire, the victim should be removed from the source, while using objects that do not conduct electric current (dry boards, rubber gloves). Helping victims of high-voltage current must be carried out in rubber shoes and gloves. In case of contact of electric wires with the ground, approaching the victim should be followed in small steps, without lifting the soles from the surface or bouncing on two closely closed legs. Otherwise, the rescuer may also suffer severe electrical shock.
With the development of the symptom complex of "imaginary death" it is necessary to conduct a complex of resuscitation measures: artificial respiration and indirect heart massage. Defibrillation is used for heart rhythm disturbances. Sometimes tracheal intubation or tracheostomy is performed for the most effective ventilation of the lungs. With the purpose of stimulation of cardiac activity, fighting with edema of the brain and lungs, sometimes infusion therapy is performed.
Medicamentous treatment of electrotrauma
Treatment of victims with electrical burns is advisable to conduct in burn hospitals. It should be guided by the basic principles of infusion-transfusion therapy, used for burn shock. For the criteria of volume and composition of media, the rate of administration and duration of therapy, it is necessary to take such indicators as hemoconcentration, hemodynamic disorders, electrolyte and acid-base conditions, disorders of kidney function. Infusion-transfusion therapy is of great importance in other periods of the disease, it is slightly different from that with extensive thermal burns.
Surgical treatment of electric trauma
Indication for surgical treatment is the presence of electric burns III-IV degree.
Local treatment of electric burns is carried out according to standard general surgical principles, taking into account the phases of the wound process and similarly to the conservative treatment of deep burns with thermal trauma aimed at the fastest preparation of wounds for a free skin transplant. Among operative methods of treatment, decompression necrotomy, necrectomy, osteonecrectomy, vascular ligation throughout, limb amputation, abscess opening and phlegmon, autodermoplasty are isolated.
In contrast to thermal electric trauma, it often requires necrectomy with excision of deep tissue (muscles, tendons, bones), which lengthens the timing of preparation of wounds for immediate closure. More often there is a need for amputation of the limbs, often simultaneously with the ligation of the vessels throughout. If the bones of the cranial vault are damaged after excision of soft tissue necrosis, craniotomy is performed. To do this, in the dead bone with the help of a cutter, multiple trephination holes with a diameter of 1-1.5 cm are made to the bleeding tissues. This manipulation helps drain the wound, shorten the time it takes to clear it from osteonecrosis, prevent intracranial purulent complications. In addition, with craniotomy, the depth of bone damage is specified. After 1.5-2 weeks, trepanation holes are performed by granulations: either from diploe (with only the external platelet necrosis), or from the dura mater or brain substance with total bone damage. After 1.5-2 months after the operation, the wound is completely cleared from necrotic tissues and covered with a granulation cover. In these terms, perform autodermoplasty.
When electric burns of extremities are often shown preventive ligation of blood vessels. Such an operation is necessary to prevent possible bleeding from the eroded parts of the vascular wall in the burn zone. Vessel ligation is performed above the lesion site outside the necrosis zone.
To restore the lost skin, all kinds of modern dermal plastics are used: free dermatome, plastic with local tissues and flaps on the feeding stem, Italian and Indian plastics, Filatov Stalk. Especially shown are non-free methods of skin plasty with soft tissue defects and skin in functionally active areas (joint area, foot support, bare bones and tendons).
Possible postoperative complications
As in the surgical treatment of deep thermal burns, the most common is melting of skin autografts and suppuration of donor wounds. When performing non-free skin plasty, the suppuration of the surgical wound is not uncommon.
Further management
Timely and professionally performed treatment of severe electrical burns in many cases does not relieve the victims of the formation of scar deformities and contractures, so the majority of such patients in the late period need reconstructive and restorative surgical treatment.