Electrical Injury, Chemical Burns,	9
and Cold Injury “Frostbite”

Shahriar Shahrokhi

9.1Electrical Injuries

9.1.1Introduction

Electrical injuries/burns comprise of a small portion of all burn unit admissions approximately <5 %; however, they have devastating consequences and are a common cause of amputations [1–5].

These injuries are divided into high voltage (>1,000 V) and low voltage (<1,000 V), and their severity is based on:

•Voltage (E)

•Current (amperage – I)

•Current type (AC vs. DC)

•Contact time

Joule’s law defines the amount of tissue damage:

Power( J ) = Current(I )2 × Resistance(R) . The higher the resistance of tissue to current flow, the greater heat generated which results in greater tissue damage. The various modalities by which electricity can cause injury are summarized in Table 9.1. The tissue damage is caused not only by Joule forces but also by electroporation and protein degradation by electro-conformation [6–9]. The cross-sectional area of the

Table 9.1 The types of electrical injury

Electrical contact	Electrical injury caused by current flow against tissue resistance
Arc	Thermal burn caused by arcing of electrical current passing through the air
Flash	Thermal burn from ignition of clothing or surroundings

S. Shahrokhi, MD, FRCSC

Division of Plastic and Reconstructive Surgery,

Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Suite D716, Toronto, ON M4N 3M5, Canada e-mail: [e-mail]

M.G. Jeschke et al. (eds.), Burn Care and Treatment,	149
DOI 10.1007/978-3-7091-1133-8_9, © Springer-Verlag Wien 2013

150	S. Shahrokhi

tissue also contributes to the severity of injury with greater damage seen in areas with smaller cross-sectional radius (wrists and ankles) [4, 5]. The current is hence responsible for the tissue damage not the voltage.

9.1.2Diagnosis and Management

High-voltage injuries should be treated as with all traumas beginning with ABCDE primary survey followed by a thorough secondary survey. Up to 15 % of all electrical injuries are associated with other traumatic injuries; most prevalent are the neurologic (traumatic brain injury – TBI) and orthopedic injuries (fractures) [4, 5, 10]. Many of the organ systems are affected by electrical injury, and these sequelae are summarized in Table 9.2.

High-voltage electrical injuries are a predominant male workforce-related injury with significant sequelae and economic cost. There are practice guidelines for the management of these injuries [16]; however, as these injuries have a low rate of occurrence, they are best managed in specialized centers adept to handling the various complications of these injuries.

In comparison, low-voltage electrical injuries (LVEI) are less common and have more varied etiologies and have less devastating initial sequelae. However, LVEI have more frequent long-term sequelae with delayed presentation and nonspecific symptoms [28, 29]. The common sequelae of LVEI are summarized in Table 9.3. These individuals tend to have a lower rate of return to work due to these neurological and psychological sequelae [29].

Table 9.2 The organ system sequelae of electrical injury and proposed management

System	Sequelae	Management
Neurologic/sensory	Loss of consciousness	Need to monitor patients and have close
[4, 5, 11–13, 24–27]	Traumatic brain injury	follow-up for possible delayed presentation
	Motor and sensory deficits
	(can be delayed)
	Tympanic membrane
	rupture
	Delayed cataracts
Cardiovascular	Arrhythmias,	Initial ECG, followed by cardiac monitor-
[14–19]	dysrhythmias	ing for up to 24–48 h based on presence of:
	Myocardial infarction	ECG abnormalities
	Vascular injury	Cardiac arrest
	(thrombosis)	Loss of consciousness
		Role of markers of cardiac damage such as
		troponin, Ck, Ck-MB unknown
Respiratory	Pneumothorax	Treat with chest tube
Abdominal [4, 5]	Blunt abdominal injury	Treat in accordance to the priority of injury
	Evisceration	as per ATLS and trauma center guidelines
	Ileus, gastroparesis