Electrical burns in children

Prof. Dr. Saad S Al Ani
Senior pediatric consultant
Head of Pediatric Department
Khorfakkan Hospital
Sharjah , UAE
anahbaghdad@gmail.com
Electrical Burns in
children
06/07/2019 Electrical burns in children Prof. Dr. Saad S Al Ani 1

06/07/2019
Electrical burns in children Prof. Dr. Saad S Al
Ani 2
https://www.networx.com/article/electrical-safety-quiz

 Q1.How does electricity move from one place to
another?
a. Electricity travels through the air.
b. Electricity travels through conductors.
c. Electricity only travels through electrical wires.
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An electrical safety quiz?

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http://clipart-library.com/clipart/1839625.htm

True or false:
 Q2.Low voltage = Low hazard
a. True
b. False
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https://www.canstockphoto.com/do-not-leave-kids-alone-4636702.html

True or false:
 Q3. You are more likely to experience an
electric shock if you touch an electrical
object with wet hands.
a. True
b. False
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https://twitter.com/singletrackelec

True or false:
 Q4. Is it safe to run an extension cord
under a carpet or along a baseboard for
permanent use?
a. True
b. False
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http://www.thinkstockphotos.in/image/stock-illustration-vector-illustration-of-kid-with/935702422

 Q5. If a friend receives a severe electric shock
from an electrical appliance in your home,
what should your first response be?
a. Grab the appliance and throw it aside so that
you can tend to your friend.
b. Run to the circuit breaker and turn off the
main switch.
c. Use a wooden broomstick to push the
appliance away safely.
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http://www.bipps.org/now-admit-no-electric-circuit-coverage-nextgen-science-standards/

 Q6. If you are doing an outdoor painting or roofing
project and there are power lines nearby, how
much space should there be between you and the
power lines in order for you to stay safe?
a. You, your tools and ladders should be at least 10
feet away from the power lines.
b. You, your tools and ladders should be at least 20
feet away from the power lines.
c. You don’t have to worry about it because power
lines are insulated, so you won’t get shocked.
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https://www.dreamstime.com/stock-photos-man-electrocuted-image20443763

Introduction
3 Types of electrical burns
1.Minor electrical burns
2.Electrical wire burns
3.Lightning burns

Minor electrical burns
Usually occur as a result of biting
on an extension cord
Produce localized burns to the
mouth

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https://www.healthline.com/health/electric-shock

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https://safety.lovetoknow.com/Electrical_Safety_Tips_for_Children

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https://www.phase1electricalservices.co.uk/advice/how-keep-children-safe-electrical-danger

Electrical Burn on Mouth. Shown is an electrical burn caused by a
110-volt household current. The injury resulted from the patient's
sucking on an extension plug
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Minor electrical burns (Cont.)
Usually involve the portion of upper
and lower lips
May involve or spare corners of the
mouth

They are nonconductive injury
Hospitalization is not necessary

Care is focused on the area of the
injury visible on the mouth
Ensuring it is low voltage and does
not cause entry and exit wounds or
cardiac issues

Treatment:
 Topical antibiotic creams
 Referral to burn unit in the
outpatient department if needed

High-tension electrical wire burns
Result from high voltage(>1,000 V)
Occur at high-voltage instillations
Mortality rate for children who arrive
to the hospital :3 -15 %

(Cont.)
Deep muscle injury is typical and
can’t be readily assessed initially
Survivors have a high rate of
morbidity including major limb
amputations

Combination of contact and flash burn .Involvement of
head and neck in high voltage injuries
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(Cont.)
Points of entry of current through the
skin and the exit site show
characteristic features
Majority of entrance wounds in upper
extremity with small exit wounds in
the lower extremity

(Cont.)
The electrical path takes the shortest
distance between the 2 points
May produce injury in any organ or
tissue in the path of the current

(Cont.)
Damage to:
- abdominal viscera
- thoracic structures
- the nervous system
can happen

(Cont.)
Cardiac abnormalities manifested as
ventricular fibrillation or cardiac arrest are
common
Initial ECG and cardiac monitoring until
stable is essential
Higher risk patients have:
+ abnormal ECG
+ history of loss of consciousness

(Cont.)
Renal damage
Results from deep muscle necrosis
myoglobinuria
 Need forced alkaline diuresis

(Cont.)
Compartment syndrome
 Results from soft tissue injury of an
extremity
 Aggressive removal of all dead tissues
is the key to effective treatment
 Early debridement facilitates early
closure of the wound

Lightning burns
Occur when:
High-voltage current directly strikes
a person ( most dangerous)
The current strikes the ground or an
adjacent (in-contact) object.

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Lightning burns (Cont.)
Depend on:
The current path
The type of clothing worn
The presence of metal
Cutaneous moisture

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https://toonclips.com/design/1460

Entry, exit and path lesions are
possible
The prognosis is poorest for
lesions of the head or legs
Internal organ injury along the
path is common

Linear burns are in the locations
where sweat is present
Feathering or arborescent patterns,
is characteristic
Ignition of clothing can produce
serious cutaneous burns

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https://sciencebasedlife.wordpress.com/2011/04/28/the-science-and-myths-behind-lightning-strikes/

Internal complications include:
 Cardiac arrest (caused by asystole)
 Transient hypertension
 Premature ventricular contractions
 Ventricular fibrillation
 Myocardial ischemia

CNS complications include:
 Cerebral edema  Mood changes
 Hemorrhage  Depression
 Seizures  Paralysis of lower
extremities

Other complications include:
 Rhabdomyolysis and myoglobinuria
 Renal failure
 Ocular manifestations include:
 Vitreous hemorrhage
 Iridocyclitis
 Retinal tearing or retinal detachment

Electrical injury :
Clinical manifestations and
management

General: Management
1. Extricate the patient
• Perform ABCs of resuscitation
• Immobilize the spine if an injury is
suspected
2. Obtain history: voltage, type of current
3. Obtain CBC ,platelet counts ,electrolytes,
BUN, creatinine and glucose

Cardiac manifestations
• Dysrhythmias
 Asystole  Premature atrial
contractions
 Ventricular
fibrillation
 Premature ventricular
contractions
 Sinus tachycardia  Conductive defects
 Sinus bradycardia  Atrial fibrillation
 St-T wave changes

Cardiac management
• Treat dysrhythmias
• Provide cardiac monitor, ECG, and
radiographs (suspect thoracic injury)
• Perform creatinine phosphokinase
with isoenzyme measurements if
indicated

Pulmonary manifestations
• Respiratory arrest
• Acute respiratory distress
• Aspiration syndrome

Pulmonary management
• Protect and maintain the airway
• Provide mechanical ventilation if
indicated
• Chest radiograph
• Arterial blood gas levels

Renal manifestations
• Acute kidney injury
• Myoglobinuria

Renal management
• Provide aggressive fluid management unless
central nervous system injury is present
• Maintain adequate urine output :> 1 ml/kg/hr.
• Consider central venous or pulmonary artery
pressure monitoring
• Measure urine myoglobin
• Perform urinalysis
• Measure BUN , creatinine

Electrical injury : Neurologic
manifestations & management

Immediate neurologic effect
Manifestations
• loss of consciousness
• Motor paralysis
• Visual disturbance
• Amnesia
• Agitation
• Intracranial hematoma
Management
• Treat seizures
• Provide fluid restriction if indicated

Secondary neurologic effect
Manifestations
• Pain
• Paraplegia
• Brachial plexus injury
• Syndrome of inappropriate
antidiuretic hormone secretion
• Autonomic disturbance
• Cerebral edema
Management
• Consider spine radiographs and MRI
especially cervical

Delayed neurologic effect
Manifestations
• Paralysis
• seizures
• Headache
• Peripheral neuropathy
Management
• Perform CT or MRI scan of the
brain if indicated

Electrical injury :cutaneous /oral
manifestations

Cutaneous /oral manifestations:1
Manifestations
• Oral commissure burns
• Tongue and dental injuries
• Skin burns resulting from ignition of clothes
• Entrance and exit burns
• Arc burns

Management
• Search for the entrance and exit wounds
• Treat cutaneous burns
• Determine patient’s tetanus status
• Obtain consultation for plastic surgery
of ear ,nose ,and throat, if indicated

Manifestations
• Electrical burns to mouth could include
oral commissures and lips
• Low-voltage electrical burns secondary to
high conductivity of saliva

Management
• Ensure no entry or exit wounds and no cardiac
involvement
• Confirm all injuries are localised
• Management is observation until eschar
sloughs off and granulation tissue fills in
• Obtain plastic surgeon evaluation after first
healing usually with scar formation

Electrical injury :abdominal
manifestations and management
Clinical manifestations Management
• Viscus perforation and
solid-organ damage
• Ileus
• Abdominal injury rare
without visible
abdominal burns
• Place nasogastric tube if
patient has airway
compromise or ileus
• Obtain serum ALT,AST
,amylase ,BUN and
creatinine
measurements and CT
scans as indicated

Electrical injury :Musculoskeletal
manifestations
• Compartment syndrome
from subcutaneous
necrosis and deep burn
• Monitor patient for
possible compartment
syndrome
• Long bone fractures ,
spine injuries
• Obtain radiographs and
orthopedic / genera;
surgery consultations as
indicated

Electrical injury :ocular
manifestations
• Visual changes
• Optic neuritis
• Cataracts
• Extraocular muscle
paresis
Obtain an
ophthalmology
consultation as
indicated

Answers to An electrical safety quiz
 Q1. B: Electricity travels through conductors such as
metal, concrete, water, wet wood, and even people.
 Q2. B: The longer a person is exposed to an electrical
shock, the more dangerous the situation becomes. A low-
voltage electrocution for a mere 3 seconds can do the
same amount of damage as a high-voltage electrocution
does in 0.03 seconds. Either way, human bodies are
damaged by electric voltage - high or low - so please be
careful.
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Answers to An electrical safety quiz
(Cont.)
 Q3. A: Water is a good conductor of electricity, which
means that wet hands can conduct electricity from the
electrical object into your body. Use extreme caution when
doing electrical work around water or in wet conditions.
 Q4. B: No. An extension cord that is covered by carpeting
can overheat and cause a fire. Running an extension cord
along a baseboard is better than underneath a rug, but
you should only use extension cords for temporary work
situations. For long-term needs, hire a qualified
electrician to install a new permanent outlet.
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Answers to An electrical safety quiz (Cont.)
 Q5. B: The safest thing to do is remove the source of electricity
by turning off the main switch of the circuit breaker. Touching
your friend is not a good idea because he or she may conduct
electricity into your body and then you will both be shocked.
Using a broomstick isn’t the best idea either because if the
wood is wet or dirty, it may also conduct electricity into your
body.
 Q6. A: Make sure to keep a distance of at least 10 feet between
you, your tools and ladders and the power lines. You should
call your utility company to see what safety measures can be
taken if you're working near power lines. And remember, power
lines may have a weather coating on them for protection
against the elements, but this will not protect you from shock.
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Pinterest

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http://shrinerschildrens.org/safetybeginsathome/

References
 Arnoldo B, Purdue GF, Kowalske K ,et al .Electrical injuries :a 20- year review. j Burn Care
Rehabil.2004;25:479-484
 Chen EH , Sareen A. Do children require ECG evaluation and inpatient telemetry after household electrical
exposures? Ann Emerg Med.2007;49:64-67
 https://www.medscape.com/content/2004/00/47/28/472812/472812_fig.html
 https://www.barnardhealth.us/forensic-pathology/electrical-burns-and-other-external-trauma.html
 http://www.ijburns.com/article.asp?issn=0971-
653X;year=2013;volume=21;issue=1;spage=67;epage=70;aulast=Kasana
 https://www.networx.com/article/electrical-safety-quiz

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vectorstock.com

Electrical burns in children

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