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If you’ve ever received an electrical shock, even a minor one, you know what a jolt to your system it can be. Even at low intensity, direct exposure to electrical energy can cause injury. At a higher voltage, electric shock injury can be deadly or cause life-altering damage to the body—and may have additional, long-range effects, even after the more obvious injuries have healed.
Although death by electricity is rare, the National Institutes of Health (NIH) reports that as many as 1,000 Americans die from electrical injuries annually. About 30,000 non-lethal injuries are associated with electricity each year, and electrical burns account for 5 percent of burn center admissions.
But most of these injuries are not the result of electric shock itself; rather, they’re traditional burn injuries caused by the heat that untethered electricity can generate. That heat can burn an individual directly or trigger flame in something nearby. It’s not unusual for injuries to be caused by burning clothing, leaves, and brush, or another source of fuel that the electrical energy has ignited.
Injuries that result from direct electrical shock are different. Electricity can cause a wide range of damage as it flows through the body—damage that can be severe, sudden, and irreversible.
Humans are composed of 70 percent water, which makes us good conductors of electricity. And electricity always takes the path of least resistance; if a person is in that path, electricity will flow through the body on its way from point A to point B.
Potential injury from electric shock can vary. Fortunate individuals may simply receive a momentary tingling after electric shock that causes no damage. Others who are less fortunate may experience a more concentrated burn that will damage muscle, nerves, and blood vessels, or may even cause organ failure.
At higher voltage, disfiguring injury can also occur. Different body parts conduct differently. When the electrical energy encounters resistance in the form of dense tissue, like bone, it can destroy it in a fraction of a second, leaving amputation as the only treatment course. Or we may see severe wounds at the spot where the electricity exited the body, as it sought the least resistive path.
And you don’t actually need to receive a huge jolt of electric current to be in trouble. Even at low intensity, electricity that reaches the heart can lead to cardiac arrest by creating an arrhythmia that leaves the heart unable to pump blood. Fortunately, such catastrophic injuries are rare.
Electricity can cause deep burn damage, sometimes with no surface evidence. @ShuppMD explains. https://bit.ly/2Z0xbbJ via @MedStarWHC
Who's at Risk?
With electricity surrounding us every day, it’s possible for electrical injuries to affect anyone. At the Burn Center here at MedStar Washington Hospital Center, we treat a number of injuries to trade professionals, such as electricians, construction workers, engineers, and landscapers. But homeowners are also at risk, particularly those who do their own renovation and repair work.
In the U.S., the NIH estimates that as many as 20 percent of electrical injuries affect children, although this number is a significant drop since the 1980s, when parents of young children began to place plastic covers on outlets and other electrical devices in the home.
The energy potential of electricity is measured in volts. A car battery has about 12.5 volts; most household electrical appliances operate on 120 volts. On an industrial level, higher voltage allows power to be transported over distances; power from a generating station is measured in hundreds of thousands of volts.
However, the most powerful electricity comes from lightning, which can generate a charge of hundreds of millions of volts.
For a person who’s in the wrong place at the wrong time, lightning can pass through the entire body. The Centers for Disease Control and Prevention reports that, remarkably, 90 percent of the estimated 300 people struck each year survive. This is likely because lightning delivers a very quick exposure, measured in milliseconds.
Unfortunately, for some, that quick exposure is enough time to initiate cardiac arrest. Although arrhythmia can often be corrected with a portable automated external defibrillator (AED), AEDs are rarely available at the scene of a lightning strike.
A lightning strike can also cause burns, muscle injuries, and even cataracts and long-term vision problems. Patients with artificial pacemakers can experience damage to the device from the jolt. Lightning also creates a shockwave of expanding air, a thunderclap that may damage the hearing of anyone nearby.
Also, both lightning and man–made electricity can physically move the victim, resulting in blunt-force trauma if the body collides with the ground, a wall, a tree, or another stationary object. Electricity can also cause loss of consciousness that precipitates a fall—with potentially serious injury if the victim falls from a ladder or roof.
Among electric shock symptoms, some patients also express neurological or vision issues after high–voltage exposure. At the Burn Center, we have observed patients who’ve lost dexterity or grip strength or reported changes in eyesight, taste, and smell after exposure.
Degrees of Burn
Burns caused by electrical accidents are given the same classifications as burns from other heat sources:
- First degree burn injuries affect the top layer of skin—for example, sunburn. When electricity is involved, the hair is sometimes singed as well, by a short blast of intense heat.
- Second degree or partial thickness burns cause blistering, resulting in a wet and “weepy” injury.
- Third degree burns affect the full thickness of the skin. They make the skin have a dry, leathery appearance and may also cause discoloration and swelling. Because a third degree burn can damage nerve endings, it is not always painful.
Both second and third degree burns can occur when electricity ignites clothing or other fuel sources nearby.
- Fourth degree burns are even more severe, when prolonged exposure to heat destroys parts of the body. These are seen in contact electrical injuries. Sometimes these can also occur in the absence of electrical injury—for example, when a person is stuck in an automobile or structural fire.
In addition to burn injuries, another common electric shock symptom is increased pressure within a muscle compartment, a disorder known as compartment syndrome. Each large muscle group in the body is essentially a compartment—the muscle is surrounded by fascia, a tough membrane that encloses and supports the muscle group. Traumatic damage from electricity can cause the muscle to swell—but because the fascia does not stretch, the swelling has nowhere to go. Pressure increases, creating pain and potentially pinching nerves and blocking blood vessels. Untreated, this scenario can spur long-term muscle or nerve damage and could go on to result in limb loss or even death.
Considered a surgical emergency, compartment syndrome can result in the loss of a limb. At the Burn Center, we assess the severity of the damage via physical examination, including sophisticated pressure testing and identifying markers in the urine, even in an unconscious burn victim.
A common procedure to treat this type of damage is fasciotomy, making an incision through the skin and fascia to reduce pressure. Although this is a complex surgery, the Burn Center team works to lessen any potential for post-recovery scarring.
Take Electrical Burns Seriously
If you receive an electrical injury, no matter the severity, I recommend having it assessed at a highly qualified burn center like the one here at the Hospital Center. Burn injuries can cause damage not readily evident on the surface.
Our approach to treatment depends on the severity and location of the burn injury. We are experienced at cardiac testing and monitoring for injuries unique to electrical exposure. Every burn is unique, but long-term goals for recovery always include managing pain, limiting scarring, and improving function and range of motion. And our team of support specialists—nurses, rehabilitation therapists, nutritionists, pharmacists, psychologists, and social workers—have the experience and knowledge to help manage the most complex cases.
Some electrical injuries may be preventable by following a few common–sense tips:
- Around the home, leave electrical work to the professionals. Stay away from overhead wires.
- Keep children away from electrical devices; cover outlets and unplug appliances not in use.
- At work, follow all safety protocols to avoid encounters with both electrical power and lightning. Always use any personal protective equipment issued.
- Follow updates from weather professionals when camping, hiking, boating, playing golf, or any other outdoor activity, and seek shelter if thunderstorms are imminent.