Electrical Injuries
An electrical injury occurs when a current passes through
the body, interfering with the function of an internal organ or sometimes
burning tissue.
Often the main symptom is a skin burn, but not all serious
injuries are visible.
Doctors check the person for abnormal heart rhythms,
fractures, dislocations, and spinal cord or other injuries.
Abnormal heart rhythms are monitored, burns are treated,
and, if the burn caused extensive internal damage, intravenous fluids and other
treatments are given.
Electrical injury may result from contact with faulty
electrical appliances or machinery or inadvertent contact with household wiring
or electrical power lines. Getting shocked from touching an electrical outlet
in the home or by a small appliance is rarely serious, but accidental exposure
to high voltage causes about 300 deaths each year in the United States.
How electricity affects the body
Electrical current passing through the body generates heat,
which burns and destroys tissues. Burns can affect internal tissues as well as
the skin. An electrical shock can short-circuit the body’s own electrical
systems, causing nerves to stop transmitting impulses or to transmit impulses
erratically. Abnormal impulse transmission can affect the
Muscles, causing them to contract violently
Heart, causing it to stop beating (cardiac arrest)
Brain, causing seizures, loss of consciousness, or other
abnormalities
The severity of the injury ranges from minor to fatal and is
determined by the following factors:
Intensity of the current
Type of current
Pathway of the current through the body
Duration of exposure to the current
Electrical resistance to the current
Intensity of the current
The intensity of the current is measured in volts and
amperes. Ordinary household current in the United States is 110 to 220 volts.
In many other countries, standard household current is 220 volts. A standard
electrical outlet in the US is 110 volts, and 220 volts is used for large
appliances such as dryers or refrigerators. Anything over 500 volts is considered
high voltage. High voltage can jump (arc) through the air anywhere from an inch
up to several feet, depending on the voltage. Thus, a person may be injured
simply by coming too close to a high-voltage line. High voltage causes more
severe injuries than low voltage and is more likely to cause internal damage.
Type of current
Electrical current is categorized as direct current (DC) or
alternating current (AC). Direct current, such as current generated by
batteries, flows in the same direction constantly. Alternating current, such as
current available through household wall sockets connected to the power grid,
changes direction 50 to 60 times per second.
Alternating current is more dangerous than direct current.
Direct current tends to cause a single muscle contraction often strong enough
to force people away from the current’s source. Alternating current causes a
continuing muscle contraction, often preventing people from releasing their
grip on the current’s source. As a result, exposure may be prolonged. Even a
small amount of alternating current—barely enough to be felt as a mild
shock—may cause the grip to freeze. Slightly more alternating current can cause
the chest muscles to contract, making breathing impossible. Even more current
can cause deadly abnormal heart rhythms (arrhythmias).
Pathway of the current
The path that the electricity takes through the body tends
to determine which tissues are affected. Because alternating current
continually reverses direction, the commonly used terms “entry” and “exit” are
inappropriate. The terms “source” and “ground” are more precise. The most
common source point for electricity is the hand, and the second most common is
the head. The most common ground point is the foot. A current that travels from
arm to arm or from arm to leg may go through the heart and is much more
dangerous than a current that travels between a leg and the ground. A current
that travels through the head may affect the brain.
Duration of exposure
In general, the longer the person is exposed to the current,
the worse the injury.
Resistance to the current
Resistance is the ability to impede the flow of electricity.
Most of the body’s resistance is concentrated in the skin. The thicker the skin
is, the greater its resistance. A thick, callused palm or sole, for example, is
much more resistant to electrical current than an area of thin skin, such as an
inner arm. The skin’s resistance decreases when broken (for example, punctured
or scraped) or when wet. If skin resistance is high, more of the damage is
local, often causing only skin burns. If skin resistance is low, more of the
damage affects the internal organs. Thus, the damage is mostly internal if
people who are wet come in contact with electrical current, for example, when a
hair dryer falls into a bathtub or people step in a puddle that is in contact
with a downed electrical line.
Symptoms of Electrical Injuries
Often, the main symptom of an electrical injury is a skin
burn, although not all electrical injuries cause external damage. High-voltage
injuries may cause massive internal burns. If muscle damage is extensive, a
limb may swell so much that its arteries become compressed (compartment
syndrome), cutting off blood supply to the limb. If a current travels close to
the eyes, it may lead to cataracts. Cataracts can develop within days of the
injury or years later. If large amounts of muscle are damaged (a disorder
called rhabdomyolysis), a chemical substance, myoglobin, is released into the
blood. The myoglobin can damage the kidneys.
Young children who bite or suck on electrical cords can burn
their mouth and lips. These burns may cause facial deformities and growth
problems of the teeth, jaw, and face. An added danger is that severe bleeding
from an artery in the lip may occur when the scab falls off, usually 5 to 10
days after the injury.
A minor shock may cause muscle pain and may trigger mild
muscle contractions or startle people, causing a fall. Severe shocks can cause
abnormal heart rhythms, ranging from inconsequential to immediately fatal.
Severe shocks can also trigger powerful muscle contractions sufficient to throw
people to the ground or to cause joint dislocations, bone fractures, and other
blunt injuries.
The nerves and brain can be injured in various ways, causing
seizures, bleeding (hemorrhage) in the brain, poor short-term memory,
personality changes, irritability, or difficulty sleeping. Damage to the nerves
in the body or a spinal cord injury may cause weakness, paralysis, numbness,
tingling, chronic pain, and erectile dysfunction (impotence).
Diagnosis of Electrical Injuries
A doctor's evaluation
Doctors check people for burns, fractures, dislocations, and
spinal cord or other injuries.
Most people who have no symptoms, have no known heart
disorders, have had only brief exposure to low levels of current, and are not
pregnant do not require testing or monitoring. An electrocardiogram (ECG) is
done to monitor the heartbeat in some people. For some people, blood and urine
tests may be needed. If people are unconscious, imaging tests such as computed
tomography (CT) or magnetic resonance imaging (MRI) of the brain may be needed.
Prevention of Electrical Injuries
Education about and respect for electricity are essential.
Making sure that all electrical devices are properly designed, installed, and
maintained helps prevent electrical injuries at home and work. Electrical
wiring should be installed and serviced by properly trained people. Outlet
guards reduce risk in homes with infants or young children.
Any electrical device that touches or may be touched by the
body should be properly grounded. Three-pronged outlets are safest. Cutting off
the lower (ground) prong of a power cord with three prongs (so that it will fit
older two-pronged plugs) is dangerous and increases the chances of electrical
injury. Circuit breakers that interrupt (trip) circuits when current as low as
5 milliamperes leaks are advisable in areas that get wet, such as kitchens and
bathrooms and outdoors.
To avoid injury from current that jumps (arcing injury),
poles and ladders should not be used near high-voltage power lines.
Treatment of Electrical Injuries
Cardiopulmonary resuscitation
Burn treatment
First the person must be separated from the current’s
source. The safest way to do so is to shut off the current—for example, by
throwing a circuit breaker or switch or by disconnecting the device from an
electrical outlet. No one should touch the person until the current has been
shut off.
High-voltage and low-voltage lines are difficult to
distinguish, especially outdoors. Shutting off current to high-voltage lines is
done by the local power company. Many well-meaning rescuers have been injured
by electricity when trying to free a person.
Once the person can be safely touched, the rescuer should
check to see if the person is breathing and has a pulse. If the person is not
breathing and has no pulse, cardiopulmonary resuscitation (CPR) should be
started immediately. Emergency medical assistance should be called for any
person who has more than a minor injury. Because the extent of an electrical
burn may be deceptive, medical assistance should be sought if any doubt exists
regarding severity.
People with rhabdomyolysis are usually given large amounts
of fluids intravenously.
A tetanus shot is given if needed.
If the injury is painful, people are given analgesics.
Skin burns are treated with burn cream and sterile
dressings. A person with only minor skin burns can usually be treated at home.
If the injury is more severe, the person is admitted to the hospital, ideally a
burn center. The person is kept in the hospital for 6 to 12 hours if any of the
following exists:
The heartbeat or results of an electrocardiogram (ECG) are
abnormal
The person has symptoms of a heart problem (for example,
chest pain or sometimes shortness of breath)
The person has other severe injuries
The person is pregnant (in many, but not necessarily all,
cases)
The person has a known heart problem (in many, but not
necessarily all, cases)
Young children who bite or suck on electrical cords should
be referred to a children’s orthodontist, an oral surgeon, or a surgeon who is
experienced in the care of these injuries.
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