Chapter 138

#### High-Yield Facts

• Even low-voltage electrical injuries can be fatal and often show no external burns.

• Higher-energy electrical injury can cause massive muscle damage and release of myoglobin.

• Sufficient fluid should be administered to maintain a urine flow of 1–1.5 mL/kg/h, 2 mL/kg/h until the urine is myglobin-free.

• Lip and oral commissure burns are initially bloodless and nearly painless, but as the eschar separates in 1–2 weeks, severe bleeding can occur as the labial artery is uncovered.

• Resuscitation of the apparently dead is the rule with lightning injuries.

#### Electrical Injuries

Electrical injuries are not common but can be frightening, devastating, and life changing. They may result in massive tissue destruction, changes in growth patterns, and neurologic injury, including chronic pain syndromes and permanent cognitive deficits, affecting the child's ability to learn and become a productive adult. Children at most risk are exploring toddlers (12–30 months), who suck on extension cords or stick things into electrical outlets, and adventuresome adolescents. The majority of victims are male. Adolescents often use the outdoors fearlessly as a proving ground, incurring injuries from climbing utility poles and trees and trespassing into transformer substations, resulting in high-voltage injuries.1

In developing countries, there are large numbers of deaths in the home, both because families tend to consider household current to be “safe” and because there is little prehospital care available.24

The old teaching on electrical injuries involves consideration of voltage, amperage, tissue resistance, duration, current type, and pathway. These terms are still used in the literature, and we will briefly consider them.

• Voltage is a measurement of the electrical “pressure” in a system. Injuries are divided into low (<1000 V) and high (>1000 V) voltage. High voltage tends to produce greater tissue destruction.

• Amperage is a measure of the rate of flow of electrons. There is a direct relationship between current and heat generated in the material through which current flows given a constant resistance.

• Resistance is a measure of the difficulty of electron flow through a given substance. Resistance is measured in ohms

When electricity enters an extremity, it flows readily through all of the tissues, generating more heat in some and more coagulative damage and desiccation in others.

The body is composed of different tissues, which express a different resistance to the flow of electrical current. Thus, body parts exposed to the same intensity and duration of current may show different degrees of heat-generated tissue injury. For a given energy, more severe injuries will occur in smaller cross-sectional areas than the same energy flowing through body parts with larger cross-sectional areas such as a thigh or the trunk. Damage can be especially high at the joints where the low-resistance tissues (muscle) are minimized and higher-resistance tissues (tendons, bone and cartilage) are maximal. Damage to internal organs may be more diffuse and hard to appreciate initially because ...

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