possibility of life-threatening electrical injury exists
wherever there is electric power or lightning. The amount
and type of current, the duration and area of exposure,
and the pathway of the current through the body determine
the degree of damage. If the current passes through
the heart or brain stem, death may occur immediately
owing to ventricular fibrillation or apnea. Current
passing through skeletal muscle can cause muscle necrosis
and contractions severe enough to result in bone fracture.
Current traversing peripheral nerves can cause acute
or delayed neuropathy. Delayed effects can include damage
to the spinal cord, peripheral nerves, bone, kidneys,
and gastrointestinal tract as well as cataracts.
Direct current is less dangerous than alternating current.
With alternating currents of 25 - 300 Hz, low voltages
tend to produce ventricular fibrillation; high voltages,
respiratory failure; intermediate voltages, both. More
than 100 mA of domestic house current of 110 volts at
60 Hz is, accordingly, dangerous to the heart, since
it can cause ventricular fibrillation. DC current contact
is more likely to cause asystole.
Lightning injuries differ from high-voltage electric
shock injuries in that lightning usually involves higher
voltage, briefer duration of contact, asystole rather
than ventricular fibrillation, nervous system injury,
and multisystem pathologic involvement.
Electrical burns are of three distinct types: flash
burns, flame burns, and the direct heating effect of
tissues by the electric current. The latter lesions
are usually sharply demarcated, round or oval, painless
yellow-brown areas with inflammatory reaction. Significant
subcutaneous damage can be accompanied by little skin
injury, particularly with larger skin surface area electrical
Electric shock may produce loss of consciousness. With
recovery there may be muscular pain, fatigue, headache,
and nervous irritability. The physical signs vary according
to the action of the current. Ventricular fibrillation
or respiratory failure can occur; the patient may be
unconscious, pulseless, hypotensive, cold and cyanotic,
and without respirations.
Electric shock may be a hazard in equipment that is
usually considered to be harmless. Proper installation,
utilization, and maintenance of equipment by qualified
personnel should minimize this hazard.
Emergency Measures :
victim must be freed from the electric current prior
to initiation of CPR or other treatment; the rescuer
must be protected. Turn off the power, sever the wire
with a dry wooden - handled axe, make a proper ground
to divert the current, or drag the victim carefully
away by means of dry clothing or a leather belt.
Lightning injury. Victims of lightning injury, in whom
coma may last for a few minutes to several days, should
receive prompt and sustained artificial resuscitation.
This should be continued as long as there is no clinical
evidence of brain death.
Hospital Measures :
or unstable electric shock victims should hospitalized
when revived and observed for shock, arrhythmia, thrombosis,
infarction, sudden cardiac dilation, hemorrhage, and
myoglobinuria. A urinalysis, serum Ck and CK-MB, and
an electrocardiogram should be obtained immediately.
Victims should also be evaluated for blunt trauma, dehydration,
skin burns, hypertension, posttraumatic stress, acid-base
disturbances, and neurologic damage. Indications for
hospitalization include significant arrhythmia or electrocardiographic
changes, large burn, loss of consciousness, pulmonary
or cardiac symptoms, or evidence of significant deep
tissue or organ damage. Extra caution is indicated when
the electroshock current has followed a transthoracic
route (hand to hand or hand to foot) and in patients
with a cardiac history.
To counteract fluid losses and myoglobinuria due to
electric shock (not lighting ) burns, aggressive hydration
with Ringer's lactate should seek to achieve a urine
output of 50-100 mL/h.
may occur in almost any part of the body but most commonly
include sepsis, gangrene requiring limb amputation,
or neurologic, cardiac, cognitive, or psychiatric dysfunction.