What are Electrical Burns: Signs, Symptoms, First Aid, Treatment, Types, Healing Time, Pathophysiology, Causes

An electrical burn is a rapidly occurring injury, which occurs as a result of passing of electricity through the body resulting in damage to the internal organs and tissues. The difference between electrical burns and thermal or chemical burns is that electrical burns cause increased subdermal damage than other types of burns. Electrical burns may only cause surface damage to the skin; however, majority of the times, there will be severe damage to the deep tissues under the skin. Because of this, it is difficult to correctly diagnose electrical burns, as many individuals tend to underestimate the severity of electrical burn. In severe cases of electrical burn, the electricity can strain the heart, cause shock to the brain and injure other organs.

A burn is classified as electrical burn, if the electricity is the direct cause of the burn. If a person burns a finger on a hot electric steam iron, then this type of burn would be a thermal burn and not electrical burn. If the electricity passes through any resistance, then there is production of heat and the current does not enter the body in this type of burn. Similarly, in cases where a fire is judged to be “electrical” in origin, it need not cause any injuries or deaths from electrical burns.

There are 4 electrical factors which determine the severity of the damage occurred as a result of electrical burns and these are:

1. Voltage.
2. Current.
3. Resistance.
4. Frequency.

The severity of the electrical burns is also dependant on the course or pathway which the current follows through the body. Usually, the current will follow the course of the tissues, which are least resistant, such as: firstly blood vessels, then nerves and muscle, after that skin, tendon, fat and lastly bone. Commonly, in most cases, electric injuries chiefly cause damage to the outer limbs, however, damage can also occur to vital areas of the body which lead to severe complications. When the body comes in contact with a source of electricity, then it becomes a part of the electrical circuit where the electrical current has a point of entry and a point of exit at two different sites of the body. The site which is the point of entry will be depressed and leathery and the site where the exit wound is located tends to be more explosive and extensive. This makes it difficult to correctly diagnose an electrical burn, as the internal damage to the body is not visible and only the entry and exit wounds can be seen.

Electrical burns are caused in various different ways, for example a person can incur electrical burns from grasping or touching electrically live objects, inserting fingers into electrical sockets, short-circuiting and falling into electrified water. Electrical burns can also occur from lightning strikes, although this is not that common an event. Due to the advancement in the technology, there is increase in the electrical burns/injuries in people and it has become the fourth leading cause of death from work-related trauma. More than half of these electrical injures occur as a result from contact from the power line. Most of the high-voltage injuries and about one third of electrical traumas are job related.

The type or classification of electrical burns is done into six categories. An electrical burn victim can suffer from any of the combination of these categories which include:

• Low-Voltage Electrical Burn: Power source of 500 volts or less, which produces electrical burn, is classified as a low-voltage burn. The current voltage is not sufficient to cause damage to the tissue present along its path except at the point of contact. The electrical burn of this type will be superficial, mild or can also be severe depending on the duration of contact.
• High Voltage Electrical Burn: This electrical burn is extremely severe and occurs when the victim comes into direct contact with high voltage supply and the incurred damage runs its course throughout the victim’s body. External burn injuries in this type of electrical burn can be misleading, as majority of the damage occurs beneath the skin and there is severe damage of the sub-dermal tissues.
• Flash Electrical Burn: These types of electrical burns occur from electrical arcs, which pass over the skin. Flash burn produces intense heat and light which can result in severe burns in a fraction of second. The burns which are produced cover a large area and are mostly superficial and the tissues under the skin are usually unaffected or undamaged.
• Arc Burn: This type of electrical burn is produced when there is passing of the electrical energy from a high-resistance area to a low-resistance area. There need not be any contact with the electric source in this type of electrical burn, as in the case of arc burn the electricity ionizes the air particles as it passes through it to finish the circuit. The heat which is produced can be very high, up to 4,000 degrees Celsius, and is hot enough to ignite the victim’s clothes and vaporize metal. The excess energy from the arc gets dissipated in a form of explosion. Other than this, a pressure wave blast, which is more than 1000 pounds per square inch of pressure, can be generated from a high-amperage arc. This type of blast causes severe injuries and can throw the victim.
• Flame Electrical Burn: This type of electrical burn occurs from touching or contact to the objects, which got ignited through an electrical source in association with arc and flash burns.
• Oral Electrical Burns: This type of electrical burn is suffered mostly by children from sucking or biting on electrical cords. The electric current usually passes from one side of the mouth to the other side and can result in deformity of the mouth/face.

Signs and symptoms of electrical burns depend on the site of burn and the severity of the electrical burn. Patient can experience symptoms immediately or after a few months and they include:

• Presence of burns/wounds on the skin, especially at the point of entry and exit of the electric path.
• Patient experiences headache, confusion, dizziness, memory loss or confusion.
• Patient may also have hearing loss.
• There is shortness of breath.
• Patient experiences weakness, muscle pain or stiffness.
• The electric current causes rapid or abnormal heartbeat.
• Patient has trouble walking or maintaining his/her balance.
• Patient feels pain all over the body.
• The color of the urine is red or reddish-black, which is a serious symptom of electrical burn and needs prompt medical attention.
• Seizures may also occur, which is also a serious symptom of electrical burn and needs prompt medical attention.

Medical history of the patient is taken where the doctor asks various questions regarding the symptoms, the modality of the electric burn. Patient is asked about any other medical condition which he/she may have and the patient’s memory is also tested. Joint movements are tested and the following tests are done to help diagnose other problems:

Blood and urine tests are done to look for damage to the heart, muscles and other organs.

ECG is done to measure the electrical activity in the heart and to check for problems or damage to the heart.

CT scan is a test which uses x-ray and computer for taking pictures of the brain. This test helps in looking for any signs of injury to the brain.

MRI scan is a test which uses computer and powerful magnets for generating pictures of the head and other parts of the body. MRI scan helps in assessing the damage to the brain, muscles, bones, joints and blood vessels.

Scintigraphy is a diagnostic test, which helps in detecting dead tissue in the body and in deciding the amount of tissue that needs to be removed.

Step 1: Call 911 or other emergency services.

Step 2: The victim of electrical burns should not be moved or touched until the source of electricity has been eliminated by unplugging or turning off the source of electricity.

Step 3: If you are not able to turn off the electrical source, then stand on a pile of paper or books or rubber mat and try to remove the patient by using a wooden stick, such as the handle of the broom.

Step 4: After removing the patient from the electrical source, try to assess the consciousness of the patient, by seeing if the patient responds to any questions asked.

Step 5: Electrical injuries comprise of not only burns, but also include cardiac arrhythmias. So, it is important to evaluate the patient’s pulse rate and circulation, followed by treatment of burns.

Step 6: If the patient is not conscious or not responding, then CPR should be started.

Step 7: Burns will be present at the site where the electrical current has entered and exited the body. If the electrical burns are not serious, then one should first remove any jewelry or clothing near the site of the burn. The burns should be rinsed with water and patted dry. A topical antibiotic should be applied and the electrical burn should be covered with a light bandage or sterile gauze. Do not break any blisters.

Antibiotic and other ointments are used to prevent infection and to promote the healing of the electrical burn. Pain medicines are given to the patient to help alleviate the pain from the electrical burn. Td vaccine is given as a booster shot for preventing tetanus and diphtheria.

Most of the times, the body surface area in an electrical burn patient is less than other types of burns; however, the risks of complications in electrical burns are higher because of the internal injuries. Many patients require hospitalization due to the damaged internal tissue. When proper treatment is not done, then complications can occur from the damaged tissue, such as formation of gaseous gangrene from the dead tissue and loss of blood circulation to the limbs. Amputation of the damaged body parts may also be needed. Patient may require repeated removal of the damaged tissue along with extensive rehabilitation. The percentage of limb amputation in patients suffering from direct electrical contact is around 75%. In severe cases of electrical burn with severe injuries or wounds, patient requires skin grafting, excision of dead tissue, debridement and repair of the damaged organs.

Debridement of the dead and damaged tissue is done to remove it from the body. This helps in decreasing inflammation, preventing infection and boosting the healing process. The lost skin is then covered with healthy skin using skin grafts and flaps. This helps in closing the wounds, preventing infection, and reducing the chances of scarring. For large burn wounds, skin flap surgery is done. Skin flaps also help in improving the appearance of the skin.

Escharotomy is a surgical procedure where an incision is made through the dead tissue into the layer of fat present below. Escharotomy helps in relieving the pressure, which is produced from swelling and improves the blood circulation.

Fasciotomy is a surgical procedure where the fascia is cut to release the pressure, which is produced from the swollen muscles due to the electrical burn. This decreases the chances of damage to the nerves, tissue and organs.

Majority of the vital functions of the body are affected from electrical burning because of which there are various electrical related injuries including:

• Damage to the arteries and veins, which can cause ischemic necrosis.
• There is interference with the electrical conductivity of vital organs, including the heart and nerves resulting in lung injury and seizures from severe damage to the central nervous system and cardiac arrest.
• Electrical interference causes involuntary contraction of the muscles, which result in bone dislocations and fractures.
• Due to the forceful nature of thrust of the body, various injuries are produced including fracture of the limbs and the spine.
• Treatment is required for all these injuries along with treatment of the burns. Rarely, due to high voltage electric shock, there can be retinal detachment and formation of cataracts in the lens of the eyes. This can occur after some days or weeks after the electrical injury.

The healing time for mild first and second degree burns is less, i.e. they will heal in a few weeks. Second degree burns which are deep may need debridement, changes of antibiotic dressings, and surgical reconstruction using skin grafts/flaps and the healing time of which will be many months along with rehabilitation. If the electrical burn is small and skin grafts have been used to surgically close them, then the burns will heal more quickly. Larger and more serious electrical burns will take around three months or more to heal. Healing time also depends on the cause, depth and the severity of the burn. If the depth of the burn is more and involves the surrounding tissue, fat, muscle and bone, then healing will be difficult and takes a longer time.

• Always keep children away from electrical cords and child safety plugs in electrical outlets should be used.
• Never ever use electrical appliances when you are wet, such as when bathing, showering etc. Standing on a dry rug or carpet when using electrical appliances is recommended.
• It is important to follow safety instructions, which come along with the electrical appliances. Some of these instructions will include not using appliances which have a damaged electrical cord and unplugging such appliances immediately. In case these cannot be done and if the damage is near the plug itself, then the circuit breaker should be turned off.
• There should be a wall cover over all power mains outlets, as this will help in avoiding accidental touching of the electrified sides between the outlet and the wall. This is extremely helpful if one has children, because they can easily put their small fingers into the gap along the sides.
• Metallic parts of electrical appliances should never be touched simultaneously when touching other metallic appliances, such as water pipes, faucets etc. Metallic parts of electrical appliances should also be not touched even when a person is partially immersed in water or if the feet are wet.
• In cases where the prongs of the electrical cord are narrow or wide, they should never be adjusted with fingertips while simultaneously adjusting the cord into the power socket.
• An ordinary vacuum cleaner should not be used in damp or wet areas. A separate vacuum cleaner with only wet vacuum should be used for such areas.
• A Ground Fault Circuit Interrupter circuit breakers or outlets should be installed by a qualified electrician in the areas where there is bare concrete flooring, plumbing, outdoors etc.
• Special precautions should be taken in swimming pools because of the use of electric pumps and lights when immersed in water.
• The 12-volts are safe voltage batteries, which are used in vehicles; however, electrical burns and explosion can still occur from a short circuit. So, it is advisable to double check the polarity before attempting a jump start. Attempts should never be made on a frozen battery.
• Old high-risk appliances, such as blow dryers or corded electric drills, should be replaced with new ones.
• When traveling abroad, it is important to inquire about the voltage because the voltages differ from country to country.
• One should never pass under or near a downed power line, even if the wire is not in direct contact.

Some basic safety rules when installing, repairing and modifying residential wiring include:

• Before starting on any type of electrical wiring work, the specific circuit breaker or the master circuit breaker should be turned off
• Always wear shoes when working. It is highly recommended to wear rubber gloves when working.
• Never touch more than one bare wire at a single time and also avoid touching bare metal with the other hand or by any other exposed skin on the body.
• If tingling is felt on the skin where it is touching the bare wire, then it means that the wire is live. In such cases, immediately let go the wire and discontinue the work.
• Do not use a light switch as a substitute for shutting off the circuit breaker, as the circuit can be wired as permanently “hot,” and the switch will only disconnect the neutral wire. So there is possibility of electrocution from hot to ground.
• It is important to use the correct thickness of wiring along with right proper ground connections.
• Rubber grommet should be used for protection for wires which run through a hole in a metal sheet.
• Both the test and dial leads should be in correct position for volts when checking the voltage with a multi-function electrical tester.
• Directions/instructions should be closely followed when using wire nut connectors and the correct size should always be used. There should be no protrusion of bare wire.
• Make sure that all the connections are firm.
• Never ever cut a live electrical wiring or cord, as it will cause shortage across the metal tool which can result in an explosion along with the possibility of electrocution.
• The neutral wiring should be treated in the same manner as you would treat a “hot” wiring.
• Proper safety procedures should always be followed whether you are working in home or in a professional capacity, such as by power-line repairmen, electricians and other industry workers.