Chapter 139

• Even low-voltage electrical injuries can be fatal if the child's skin resistance is decreased by sweat or soapy bath water where the entire energy travels to vulnerable areas such as the heart. These often show no external or internal burns.
• Higher energy electrical injury can cause massive muscle damage and release of myoglobin. Without adequate early fluid resuscitation, myoglobinuric renal failure can occur.
• Standard burn formulas such as the Parkland formula cannot be used for electrical burn resuscitation, because the underlying deep tissue damage may have no relationship to overlying skin burns. Sufficient fluid should be administered to maintain a urine flow of 1 to 1.5 mL/kg/h.
• Very young children may suck on electrical cords, sustaining severe orofacial injuries that are often full-thickness, involving the lips and oral commissure. These burns are initially bloodless and nearly painless, but as the eschar separates in 1 to 2 weeks, severe bleeding can occur as the labial artery is uncovered.
• Both electrical and lightning injuries can result in postconcussion syndromes, which include GI symptoms and resistant headaches. Longer term sequelae include chronic pain syndromes, cognitive deficits, personality changes, sleep difficulties, and atypical seizures.
• No place outside is safe when thunderstorms are in the area. All camps and sports venues in lightning-prone areas should have lightning safety plans.
• Cardiac arrest at the time of the injury is the only cause of death. “Reverse triage” (resuscitation of the apparently dead) is the rule since victims who have a pulse and respirations will recover, even if they suffer permanent disabilities.
• Lightning injuries may occur indoors as children use hard-wired phones, game stations, and computers.
• Lightning causes neurologic and blunt musculoskeletal injury from secondary impact. Burns occur in less than one-third of the victims and are almost always quite superficial.

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

### Electrophysiology

The old teaching on electrical injuries involved consideration of voltage, amperage, tissue resistance, duration, current type, and pathway. Unfortunately, taken together, these factors are much too complex to be used in predicting the extent of an injury. When taken separately, they often give simplistic answers that are not borne out in the individual patient. However, 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 ...

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