ELECTRICAL

BURN

Xantipphy Mae Ibrahim

General Objective :
To be able to present a case discussion of a patient
with a high voltage electrical burn injury,

 To present the primary survey of the patient

 To present the secondary survey of the patient
 To discuss a brief anatomy of the involved system/ organ.
 To discuss different types of burn injuries
 To discuss the management of burn injuries
General Data

NAME R.A
AGE/ SEX 20/M
ADDRESS ZSP
EDUCATION Highschool, Graduate
NATIONALITY Filipino
RELIGION Roman Catholic
CHIEF COMPLAINT

Electrical burn, High voltage

Primary Survey

AIRWAY
(-) Obstruction
(-) Epistaxis
(+) circumoral burn
(-) Edema
(-) Singeing of facial/nasal hair
BREATHING
Respiratory Rate: Regular
O2 Saturation: 98%
CIRCULATION
– Pulse rate: 75
– Cold to touch
– (+)minimal bleeding on upper extremities
– Capillary refill time <2 seconds
DISABILITY (Mental State)
 GCS 15 (E4V5M6)

EXPOSURE and ENVIRONMENTAL CONTROL

 Patient sustained injury when he was working. He accidentally fell
and held onto a high voltage wire.
 He was immediately brought to ZCMC for further evaluation and
management.
Secondary Survey

 ALLERGIES: None
 MEDICATIONS: None
 PREV HOSPITALIZATION: Non
 LAST MEAL : 6 AM
 EVENTS: Patient sustained injury when he was working
 NOI: Work related injury ( Electrocution)
 POI: ZSP
 DTOI: October 27, 2018 at 9:00 AM
 DTOE: October 27, 2018 at 9:16 AM
 HISTORY PHYSICAL EXAMINATION

Erythematous,
Patient sustained injury painful,fluid filled
when he was working. He blisters, dark leathery
accidentally fell and held burn injury on:
onto a high voltage wire. Face
Anterior thorax
Bilateral upper
extremities
Right lower extremity )
perineum
 Clinical Impression

Deep Partial Thickness

Electrical Burn 47% TBSA
(Face, anterior thorax,
bilateral upper extremities,
right lower extremity,
perineum)
• Diagnostics
CBC, platelet, blood typing Within normal range
Serum K, Na, Mg, Ca No electrolyte derangements
Urinalysis (-) hematuria
BUN, Creatinine Normal
Arterial Blood Gas
CXR- PA upright
12 lead ECG
Anatomy

LAYERS OF THE SKIN

 Epidermis
 Dermis
 Subcutaneous or
Hypodermis
 • Stratum corneum
• Lymphocytes, Keratinocytes & Melanocytes

Epidermis • Langerhan, Merker, Toker cells

• Sweat Glands
• Pilosebaceous Follicles
• Nails and Epidermal Appendages

• Cutaneous Vasculature
Dermis • Cutaneous Innervation
• Fibroblasts and collagen

• Adipocytes
Subcuatenous • Thermoregulation, protection,
fat storage and insulation
 CASE DISCUSSION :
ELECTRICAL BURNS
– Cellular damage due to electrical current
– High vs. low tension injuries : 1,000 Volts dividing line
Pathophysiology

Joule Effect:
Passage of current through a solid conductor
results in conversion of electrical energy to
heat.
Nerves and Blood Vessels : Good to excellent
conduction
Muscle, Bone and Skin :Resistant to passage of
electricity
 Classification of Burns

THERMAL
• Flame
ELECTRICAL • Contact CHEMICAL
• Scald
Burn Depth
Superficial
• Painful
• No blisters

Partial Thickness
• Superficial vs. deep
• Extremely painful (dermal involvement)
• Weeping and blistered

Full Thickness
• Leathery
• Painless
• Non - blanching

Fourth Degree
 Zones of Tissue Injury
• Center of the wound
• frankly necrotic
COAGULATION • much like a third- or fourth-degree burn
• need excision and grafting

• degrees of vasoconstriction
• resultant ischemia,
STASIS • much like a second-degree burn

• heal with minimal or no scarring

• most like a superficial or first-degree burn.
HYPEREMIA
 Rule of Nine
• anterior and posterior trunk each
account for 18%,

• each lower extremity is 18%

• each upper extremity is 9%

• head is 9%.
Lund and Browder Chart
Initial Evaluation

Involves four crucial assessments:

 airway management
 evaluation of other injuries
 estimation of burn size
 and diagnosis of CO and cyanide poisoning.
Referral to a Burn Center
Resuscitation
– Parkland or Baxter formula, consists of 3 to 4 mL/kg/% burn of
lactated Ringer’s, of which half is given during the first 8 hours
after burn and the remaining half is given over the subsequent
16 hours. ****
– The burn (and/or inhalation injury) drives an inflammatory
response that leads to capillary leak; as plasma leaks into the
extravascular space, crystalloid administration maintains the
intravascular volume.
– As in any critically ill patient, a target MAP of 60 mmHg ensures
optimal end-organ perfusion. Goals for urine output should be 30
mL/h in adults and 1 to 1.5 mL/kg/h in pediatric patients.
Treatment
Medicine Description MOA Advantages Disadvantages

Silver 1% water- Silver ion • Wide range of • Poor Eschar

Sulfadiazine soluble cream binds with antimicrobial penetration
– Table with advantage
the DNAandof disadvantages
activity • Neutropenia
• Retard
(S.aureus, E.coli, Combination of organism • Inexpensive and
Klebsiella, wound
sulfadiazine releasing the easily applied
species, P. healing
and silver. sulfonamide, and has soothing • Destroys skin
aeruginosa,
Which qualities grafts
Proteus species,
and C. albicans) Prophylaxis interferes • Not absorbed • Contraindica
rather than with the systematically ted on burns
treatment intermediary • Minimal or donor
metabolic metabolic sites close to
Last up to 24 pathway of derangements newly
hours grafted
the microbe.
areas.
Medicine Description MOA Advantages Disadvantages

Mafenide Acetate 8.5% water- Bacteriostatic • Effective even in • Pain with

soluble for many the presence of application
cream and a 5% gram-negative eschar to partial-
aqueous solution. and gram-
• Excellent for thickness
positive
fresh skin grafts. burns.
Broad range of organisms,
• Absorbed
microorganisms, including Pseu • Treating and
Preventing systematicall
especially against domonas
wound infections y
all strains of P. aeruginosa
• Metabolic
aeruginosa and and certain
acidosis
Clostridium. strains of
anaerobes.
Medicine Description MOA Advantages Disadvantages

Silver It has been Bacteriostatic • Broad- Hyponatr

reinstated as a for many spectrum emia
Nitrate 0.5% solution, gram-negative
and gram-
Causes
Topical solution positive
black
organisms,
including Pseu stains
domonas
aeruginosa
and certain
strains of
anaerobes.
Medicine Description MOA Advantages Disadvantages

bacitracin, It has been Bacitracin interf • These are also Nephrotoxicity.

neomycin, reinstated as a eres with the useful for
0.5% solution, dephosphorylat superficial
and ion of C55- partial thickness
polymyxin B Topical solution isoprenyl • Meshed skin
pyrophosphate. grafts
Smaller burns or
larger burns that
are nearly Neomycin
healed, inhibits
bacterial
protein
synthesis

Polymyxins inte
ract with
lipopolysacchar
ide (LPS)
Surgical Management

1. Escharotomy
2. Fasciotomy
3. Grafting
 Complications

Compartment Syndrome
Arrythmias
Rhabdomyolysis
Renal Failure
Infections
Curling’s Ulcer
Thank you 