Modern concepts of treatment and prevention of electrical burns

Electric injuries account for 1,000 deaths in the United States, with a mortality rate of 3--15%. As the widespread use of electricity and injuries from it increase, all health professionals involved in burn care must appreciate its physiological and pathological effects as well as management of electrical current injury. Electric current exists in two forms: alternating current and direct current. The effects of electricity on the body are determined by seven factors: (1) type of current, (2) amount of current, (3) pathway of current, (4) duration of current, (5) area of contact, (6) resistance of the body, and (7) voltage. Electrical accidents can be divided into less than 1,000 V (low-voltage accidents) and greater than 1,000 V (high-voltage accidents). In any electrical accident, the witness must turn off the power source and initiate treatment at the scene of the injury. Low-voltage electric burns almost exclusively involve either the hands or oral cavity. Surgical treatment will vary with the severity of the injury. Burns caused by contact with a high-voltage alternating electric circuit conforms to two types: burns from an electric arc and burns from an electric current. High-voltage electric current injuries have a wide variety of systemic manifestations, including neurologic complications, cardiovascular and pulmonary manifestations, vascular damage, and abdominal, bone, eye and joint complications. An organized approach to the management of these complications is outlined in this article. The best treatment of burn injuries remains prevention. Because the majority of burn injuries are due to occupational electrical injuries, the regional burn centers must work effectively with industry to prevent these potentially life-threatening accidents.