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Electrical Injuries

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Essential Burn Care for Non-Burn Specialists

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Abstract

Electricity is the power source of modern society responsible for driving much of our technology. With that power comes a great opportunity but also the potential for great harm. Electrical injuries make up approximately 4% of burn center admissions in the United States. Electrical injuries can be the result of true electric current flow, arc injuries, flash and flame burns, and lightning strikes. The basic principles of care for these patients are similar to other burn injuries, however specialized expertise is required for several specific concerns. These patients may develop compartment syndrome requiring urgent exploration and decompression. Indications for cardiac monitoring must also be part of the evaluation. And complications regarding resuscitation such as pigmented urine and the development of acute tubular necrosis must also be considered. While these injuries make up a small percentage of overall admissions, they can be devastating and have great impact on patient outcome.

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References

  1. http://www.ameriburn.org/resources_factsheet.php. Accessed 21 Oct 2021.

  2. Arnoldo BD, Purdue GF, Kowalske K, et al. Electrical injuries: a 20-year review. J Burn Care Rehabil. 2004;25(6):479–84.

    Article  PubMed  Google Scholar 

  3. Baxter CR, Waeckerle JF. Emergency treatment of burn injury. Ann Emerg Med. 1988;17(12):1305–15.

    Article  CAS  PubMed  Google Scholar 

  4. Skoog T. Electrical injuries. J Trauma. 1970;10(10):816–30.

    Article  CAS  PubMed  Google Scholar 

  5. Cawley JC, Homce GT. Occupational electrical injuries in the United States, 1992–1998, and recommendations for safety research. J Saf Res. 2003;34(3):241–8.

    Article  Google Scholar 

  6. Taylor AJ, McGwin G Jr, Davis GG, Brissie RM, Rue LW 3rd. Occupational electrocutions in Jefferson County, Alabama. Occup Med (Lond). 2002;52(2):102–6.

    Article  CAS  PubMed  Google Scholar 

  7. Wick R, Gilbert JD, Simpson E, Byard RW. Fatal electrocution in adults—a 30-year study. Med Sci Law. 2006;46(2):166–72.

    Article  PubMed  Google Scholar 

  8. Nichter LS, Braynt CA, Kenney JG, et al. Injuries due to commercial electric current. J Burn Care Rehabil. 1984;5:124–37.

    Article  Google Scholar 

  9. Lee RC. Cell injury by electric forces. Ann N Y Acad Sci. 2005;1066:85–91.

    Article  CAS  PubMed  Google Scholar 

  10. Arnoldo B, Klein M, Gibran NS. Practice guidelines for the management of electrical injuries. J Burn Care Res. 2006;27(4):439–47.

    Article  PubMed  Google Scholar 

  11. Hunt JL, Mason AD Jr, Masterson TS, Pruitt BA Jr. The pathophysiology of acute electric injuries. J Trauma. 1976;16(5):335–40.

    Article  CAS  PubMed  Google Scholar 

  12. Grube BJ, Heimbach DM, Engrav LH, Copass MK. Neurologic consequences of electrical burns. J Trauma. 1990;30(3):254–8.

    Article  CAS  PubMed  Google Scholar 

  13. Lee RC, Zhang D, Hannig J. Biophysical injury mechanisms in electrical shock trauma. Annu Rev Biomed Eng. 2000;2:477–509.

    Article  CAS  PubMed  Google Scholar 

  14. Hunt JL, McManus WF, Haney WP, Pruitt BA Jr. Vascular lesions in acute electric injuries. J Trauma. 1974;14(6):461–73.

    Article  CAS  PubMed  Google Scholar 

  15. Pilecky D, Vamos M, Bogyi P, et al. Risk of cardiac arrhythmias after electrical accident: a single-center study of 480 patients. Clin Res Cardiol. 2019;108:901–8.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Rai J, Jeschke MG, Barrow RE, Herndon DN. Electrical injuries: a 30-year review. J Trauma. 1999;46(5):933–6.

    Article  CAS  PubMed  Google Scholar 

  17. Pensler JM, Rosenthal A. Reconstruction of the oral commissure after an electrical burn. J Burn Care Rehabil. 1990;11(1):50–3.

    Article  CAS  PubMed  Google Scholar 

  18. Sadove AM, Jones JE, Lynch TR, Sheets PW. Appliance therapy for perioral electrical burns: a conservative approach. J Burn Care Rehabil. 1988;9(4):391–5.

    Article  CAS  PubMed  Google Scholar 

  19. Centers for Disease Control and Prevention. Lightning-associated deaths—United States, 1980–1995. MMWR Morb Moral Wkly Rep. 1998;47(19):391–4.

    Google Scholar 

  20. Tribble CG, Pershing JA, Morgan RF, Kenney JG, Edlich RF. Lightning injuries. Compr Ther. 1985;11(2):32–40.

    CAS  PubMed  Google Scholar 

  21. Hiestand DGC. Lightning-strike injury. J Intensive Care Med. 1988;3:303–14.

    Article  Google Scholar 

  22. Cherington M. James Parkinson: links to Charcot, Lichtenbergh, and lightning. Arch Neurol. 2004;61(6):977.

    Article  PubMed  Google Scholar 

  23. ten Duis HJ, Klasen HJ, Nijsten MW, Pietronero L. Superficial lightning injuries—their “fractal” shape and origin. Burns Incl Therm Inj. 1987;13(2):141–6.

    Article  PubMed  Google Scholar 

  24. Fahmy FS, Brinsden MD, Smith J, Frame JD. Lightning: the multisystem group injuries. J Trauma. 1999;46(5):937–40.

    Article  CAS  PubMed  Google Scholar 

  25. Moran KT, Thupari JN, Munster AM. Electric and lightning-induced cardiac arrest reversed by cardiopulmonary resuscitation. JAMA. 1986;255(16):2157.

    Article  CAS  PubMed  Google Scholar 

  26. Rahmani SH, Faridaalaee G, Jahangard S. Acute transient hemiparesis induced by lightning strike. Am J Emerg Med. 2015;33(7):984.e981–3.

    Article  Google Scholar 

  27. Lee MS, Gunton KB, Fischer DH, Brucker AJ. Ocular manifestations of remote lightning strike. Retina. 2002;22(6):808–10.

    Article  PubMed  Google Scholar 

  28. Norman ME, Albertson D, Younge BR. Ophthalmic manifestations of lightning strike. Surv Ophthalmol. 2001;46(1):19–24.

    Article  CAS  PubMed  Google Scholar 

  29. Yi C, Liang Y, Jiexiong O, Yan H. Lightning-induced cataract and neuroretinopathy. Retina. 2001;21(5):526–8.

    Article  CAS  PubMed  Google Scholar 

  30. Handa JT, Jaffe GJ. Lightning maculopathy. A case report. Retina. 1994;14(2):169–72.

    Article  CAS  PubMed  Google Scholar 

  31. Dhillon PS, Gupta M. Ophthalmic manifestations postlightning strike. BMJ Case Rep. 2015;2015:bcr2014207594.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Bergstrom L, Neblett LW, Sando I, Hemenway WG, Harrison GD. The lightning-damaged ear. Arch Otolaryngol. 1974;100(2):117–21.

    Article  CAS  PubMed  Google Scholar 

  33. Modayil PC, Lloyd GW, Mallik A, Bowdler DA. Inner ear damage following electric current and lightning injury: a literature review. Eur Arch Otorhinolaryngol. 2014;271(5):855–61.

    Article  CAS  PubMed  Google Scholar 

  34. Charcot JM. Des accidents nerveux provoque’ par la fondre. Bull Med. 1889;3:1323–6.

    Google Scholar 

  35. Muehlberger T, Vogt PM, Munster AM. The long-term consequences of lightning injuries. Burns. 2001;27(8):829–33.

    Article  CAS  PubMed  Google Scholar 

  36. Primeau M. Neurorehabilitation of behavioral disorders following lightning and electrical trauma. NeuroRehabilitation. 2005;20(1):25–33.

    Article  PubMed  Google Scholar 

  37. Orak M, Ustundag M, Guloglu C, Gokhan S, Alyan O. Relation between serum pro-brain natriuretic peptide, myoglobin, CK levels, and morbidity and mortality in high voltage electrical injuries. Intern Med. 2010;49(22):2439–43.

    Article  CAS  PubMed  Google Scholar 

  38. Chandra NC, Siu CO, Munster AM. Clinical predictors of myocardial damage after high voltage electrical injury. Crit Care Med. 1990;18(3):293–7.

    Article  CAS  PubMed  Google Scholar 

  39. Das KM. Electrocardiographic changes following electric shock. Indian J Pediatr. 1974;41(316):192–4.

    Article  CAS  PubMed  Google Scholar 

  40. Arnoldo BD, Purdue GF. The diagnosis and management of electrical injuries. Hand Clin. 2009;25(4):469–79.

    Article  PubMed  Google Scholar 

  41. Housinger TA, Green L, Shahangian S, Saffle JR, Warden GD. A prospective study of myocardial damage in electrical injuries. J Trauma. 1985;25(2):122–4.

    Article  CAS  PubMed  Google Scholar 

  42. McBride JW, Labrosse KR, McCoy HG, et al. Is serum creatinine kinase-MB in electrically injured patients predictive of myocardial injury? JAMA. 1986;255(6):764–8.

    Article  CAS  PubMed  Google Scholar 

  43. Dilworth DHD, Alford P. Evaluation of myocardial injury in electrical burn injuries. J Burn Care Rehabil. 1998;10:S239.

    Article  Google Scholar 

  44. Saracoglu A, Kuzucuoglu T, Yakupoglu S, et al. Prognostic factors in electrical burns: a review of 101 patients. Burns. 2014;40(4):702–7.

    Article  PubMed  Google Scholar 

  45. Purdue GF, Hunt JL. Electrocardiographic monitoring after electrical injury: necessity or luxury. J Trauma. 1986;26(2):166–7.

    Article  CAS  PubMed  Google Scholar 

  46. Waldmann V, Narayanan K, Combes N, et al. Electrical cardia injuries: current concepts and management. Eur Heart J. 2018;39:1459–65.

    Article  PubMed  Google Scholar 

  47. Bailey B, Gaudreault P, Thivierge RL. Experience with guidelines for cardiac monitoring after electrical injury in children. Am J Emerg Med. 2000;18(6):671–5.

    Article  CAS  PubMed  Google Scholar 

  48. Wallace BH, Cone JB, Vanderpool RD, et al. Retrospective evaluation of admission criteria for paediatric electrical injuries. Burns. 1995;21(8):590–3.

    Article  CAS  PubMed  Google Scholar 

  49. Zubair M, Besner GE. Pediatric electrical burns: management strategies. Burns. 1997;23(5):413–20.

    Article  CAS  PubMed  Google Scholar 

  50. Nolan JP, Soar J, Cariou A, et al. European Resuscitation Council and European Society of Intensive Care Medicine guidelines for post-resuscitation care 2015: section 5 of the European Resuscitation Council guidelines for resuscitation 2015. Resuscitation. 2015;95:202–22.

    Article  PubMed  Google Scholar 

  51. Boyd AN, Hartman BC, Sood R, Walroth TA. A voltage-based analysis of fluid delivery and outcomes in burn patients with electrical injuries over a 6-year period. Burns. 2019;45:869–75.

    Article  CAS  PubMed  Google Scholar 

  52. Bhavsar P, Rathod KJ, Rathod D, Chamania CS. Utility of serum creatinine, creatine kinase and urinary myoglobin in detecting acute renal failure due to rhabdomyolysis in trauma and electrical burns patients. Indian J Surg. 2013;75(1):17–21.

    Article  PubMed  Google Scholar 

  53. Melli G, Chaudhry V, Cornblath DR. Rhabdomyolysis: an evaluation of 475 hospitalized patients. Medicine (Baltimore). 2005;84(6):377–85.

    Article  PubMed  Google Scholar 

  54. Coban YK. Rhabdomyolysis, compartment syndrome and thermal injury. World J Crit Care Med. 2014;3(1):1–7.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Elliott KG, Johnstone AJ. Diagnosing acute compartment syndrome. J Bone Jt Surg Br. 2003;85(5):625–32.

    Article  Google Scholar 

  56. Burton AC. On the physical equilibrium of small blood vessels. Am J Phys. 1951;164(2):319–29.

    Article  CAS  Google Scholar 

  57. d’Amato TA, Kaplan IB, Britt LD. High-voltage electrical injury: a role for mandatory exploration of deep muscle compartments. J Natl Med Assoc. 1994;86(7):535–7.

    PubMed  PubMed Central  Google Scholar 

  58. Hussmann J, Kucan JO, Russell RC, Bradley T, Zamboni WA. Electrical injuries—morbidity, outcome and treatment rationale. Burns. 1995;21(7):530–5.

    Article  CAS  PubMed  Google Scholar 

  59. Lee RC. Injury by electrical forces: pathophysiology, manifestations, and therapy. Curr Probl Surg. 1997;34(9):677–764.

    Article  CAS  PubMed  Google Scholar 

  60. Barillo DJ, Arabitg R, Cancio LC, Goodwin CW. Distant pedicle flaps for soft tissue coverage of severely burned hands: an old idea revisited. Burns. 2001;27(6):613–9.

    Article  CAS  PubMed  Google Scholar 

  61. Boozalis GT, Purdue GF, Hunt JL, McCulley JP. Ocular changes from electrical burn injuries. A literature review and report of cases. J Burn Care Rehabil. 1991;12(5):458–62.

    Article  CAS  PubMed  Google Scholar 

  62. Van Johnson E, Kline LB, Skalka HW. Electrical cataracts: a case report and review of the literature. Ophthalmic Surg. 1987;18(4):283–5.

    PubMed  Google Scholar 

  63. Saffle JR, Crandall A, Warden GD. Cataracts: a long-term complication of electrical injury. J Trauma. 1985;25(1):17–21.

    Article  CAS  PubMed  Google Scholar 

  64. Mutlu FM, Duman H, Cil Y. Early-onset unilateral electric cataract: a rare clinical entity. J Burn Care Rehabil. 2004;25(4):363–5.

    Article  PubMed  Google Scholar 

  65. Petty PG, Parkin G. Electrical injury to the central nervous system. Neurosurgery. 1986;19(2):282–4.

    Article  CAS  PubMed  Google Scholar 

  66. Singerman J, Gomez M, Fish JS. Long-term sequelae of low-voltage electrical injury. J Burn Care Res. 2008;29(5):773–7.

    Article  PubMed  Google Scholar 

  67. Theman K, Singerman J, Gomez M, Fish JS. Return to work after low voltage electrical injury. J Burn Care Res. 2008;29(6):959–64.

    Article  PubMed  Google Scholar 

  68. Ko SH, Chun W, Kim HC. Delayed spinal cord injury following electrical burns: a 7-year experience. Burns. 2004;30(7):691–5.

    Article  PubMed  Google Scholar 

  69. Shih J, Shahrokhi S, Jeschke M. Review of adult electrical burn injury outcomes worldwide: an analysis of low-voltage versus high-voltage electrical injury. J Burn Care Res. 2017;38(1):e293–w298.

    Article  PubMed  Google Scholar 

  70. Kelley KM, Tkachenko TA, Pliskin NH, Fink JW, Lee RC. Life after electrical injury. Risk factors for psychiatric sequelae. Ann N Y Acad Sci. 1999;888:356–63.

    Article  CAS  PubMed  Google Scholar 

  71. Helm PA, Walker SC. New bone formation at amputation sites in electrically burn-injured patients. Arch Phys Med Rehabil. 1987;68(5 Pt 1):284–6.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of South Florida Morsani School of Medicine, Tampa, FL, USA

    Manrique Guerrero

  2. Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Casey Kohler & Brett Arnoldo

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  1. Manrique Guerrero
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  2. Casey Kohler
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  3. Brett Arnoldo
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Correspondence to Manrique Guerrero .

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Editors and Affiliations

  1. Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA

    Jong O. Lee

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Guerrero, M., Kohler, C., Arnoldo, B. (2023). Electrical Injuries. In: Lee, J.O. (eds) Essential Burn Care for Non-Burn Specialists. Springer, Cham. https://doi.org/10.1007/978-3-031-28898-2_12

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  • DOI: https://doi.org/10.1007/978-3-031-28898-2_12

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