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Electrocution
Medical expert of the article
Last reviewed: 04.07.2025
Electrical trauma is an injury caused by exposure of organs and tissues to high-power or high-voltage electric current (including lightning); characterized by damage to the nervous system (convulsions, loss of consciousness), circulatory and/or respiratory disorders, and deep burns.
An electrical burn is a burn caused by the passage of an electric current of significant strength and voltage through tissue; it is characterized by a great depth of damage.
ICD-10 code
- T75.4 Effects of electric current.
- W85 Accident involving power line.
- W86 Accident involving other specified electrical current source.
- W87 Accident involving unspecified electric current source.
- XZZ Victim of a lightning strike.
Epidemiology
Electrical injuries occur in 1-2.5% of all types of injuries. Most often, electrical injuries are observed in people working with devices and installations that are under voltage. According to international statistics, electrical injuries account for 0.2% of all industrial accidents, and fatal injuries from them - 2-3%, which significantly exceeds the lethality from other types of injuries.
What causes electrical injury?
The etiological factor of electrical trauma and electrical burns is electric current of varying voltage and strength.
How does electrical injury develop?
Electrical trauma is a special type of thermal damage. The specific effect consists of electrochemical, thermal and mechanical effects. Electrochemical includes electrolysis, as a result of which the ionic balance in cells is disrupted and the biological potential changes. Redistribution of negatively and positively charged ions significantly changes the functional state of cells and causes the formation of coagulation necrosis in some areas and colliquation necrosis in others. The thermal effect of electric current leads to burns of the skin and underlying tissues up to charring. As a result of the mechanical action of the current, delamination and rupture of soft tissues are observed, less often - tearing off of body parts.
The non-specific effect of electric current is caused by other types of energy. In particular, a volt arc (temperature up to 40,000 °C) causes thermal burns of the skin and eyes. A fall from a height with an electric shock can result in dislocations of joints, bone fractures, and damage to internal organs. Convulsive muscle contractions can lead to avulsion fractures of bones. If the victim's clothing catches fire as a result of exposure to current, electrical injury can be combined with severe burns of the skin. Factors that aggravate the degree of injury from electric current include high air humidity, overheating of the body, exhaustion, chronic diseases, and alcohol intoxication.
Electric current causes local and general changes in the victim's body. The severity of the injury depends on the parameters of the electric current, the paths of its distribution in the body, the nature of the damage to organs and tissues, and the general condition of the victim. Death can sometimes occur immediately after injury (in 2-3 minutes) from paralysis of the vital structures of the medulla oblongata. When the current passes through the upper loop (arm-arm), death occurs from cardiac arrest as a result of myocardial damage.
Often, victims experience a state of "apparent death" - deep depression of the central nervous system, leading to inhibition of the centers of the cardiovascular and respiratory systems as a result of high-voltage current or, under certain conditions, low voltage (220 V). In such a situation, the cause of "apparent death" is considered to be the suppression of the functions of the medulla oblongata, ventricular fibrillation of the heart and tetanic spasm of the respiratory muscles.
The peculiarity of contact electrical burns is local deep tissue damage with minimal skin burn, and the necrosis zone is larger when vessels are involved along the current path due to their thrombosis. When the main arteries of the extremities are affected, gangrene occurs, and the possibility of thromboembolism of the vessels of the lungs and brain cannot be ruled out.
The course of the wound process in electrical burns is subject to general patterns and includes inflammation, suppuration, rejection of dead tissue, formation of granulation, scarring. Unlike thermal burns, the period of rejection of necrosis is up to 6-7 weeks, complications (phlegmon, arthritis, lymphadenitis, lymphangitis) are added much more often.
Symptoms of electrical injury
During an electrical injury, various pathological processes occur in the victim's body. First of all, this concerns the central nervous system: loss of consciousness, often motor and speech arousal, increase or decrease of tendon and skin reflexes are possible. Changes in the cardiovascular system are characterized by an increase or decrease in blood pressure, atrial fibrillation, ventricular fibrillation. Usually, these changes are found at the moment of injury or in the immediate hours after it, sometimes they persist for a longer time.
In the acute period, widespread vascular spasm and increased general peripheral resistance often occur, accompanied by cold extremities, cyanosis, and decreased sensitivity. Arterial thrombosis is also observed, leading to muscle damage in places where electric current passes. Such pathology is sometimes difficult to diagnose, since the skin over them almost always remains unchanged. Angio- and scintigraphy, diagnostic necrotome incisions are used for early diagnosis. Subsequently, the affected muscle tissue undergoes purulent melting, which is accompanied by severe intoxication, the development of sepsis, and acute renal failure.
Electric current also affects internal organs: nest necrosis can be observed in the gastrointestinal tract, liver, lungs, pancreas, which is caused by circulatory disorders. Diagnosis is difficult due to unclear and weakly expressed symptoms. If the place of application of electric current is the head, visual disorders (damage to the cornea, retinal detachment, optic neuritis, glaucoma) and hearing disorders can be observed.
When a low-amperage current (up to 10 mA) passes, pain may occur at the point of contact with the live object, a feeling of "goosebumps"; with a stronger current (up to 15 mA), the pain spreads to the entire area of contact, involuntary muscle contraction occurs, and the victim cannot tear himself away from the electric wire. Under the influence of a current of 50 mA or more, involuntary contractions of the chest muscles, loss of consciousness, weakening of cardiac activity, respiratory depression up to "apparent death" are observed. Currents of 0.1 A are very dangerous, and 0.5 A are fatal to humans.
Classification of electrical injury
In accordance with the accepted classification, electrical trauma is divided into degrees, however, it is justified to single out only two of them, since they are almost always deep: III - necrosis of the skin and subcutaneous fat, IV - necrosis of muscles and bones.
How is electrical injury recognized?
Local changes in electrical burns may be of a contact nature - at the entry, exit and propagation path of the current; damage from the flame of an arc or burning clothing is possible. "Current marks" are more often located on the upper limbs, are round in shape with a diameter from several millimeters to 2-3 cm, sometimes have the appearance of a cut wound, abrasion, pinpoint hemorrhage. Mixed damage is also possible: a combination with a burn from an arc flame or with mechanical trauma.
Most often, electrical trauma is represented by a white or black scab. Sometimes, with a burn with a voltage of 6000-10,000 V, torn dark-colored muscles protrude into the wound. Edema of soft tissues increases quite quickly, which is largely facilitated by increased permeability of the vascular wall.
Electrical trauma is often accompanied by damage to the bones of the cranial vault due to the insignificant thickness of soft tissues. A dense, immobile, dark-colored scab forms at the site of the burn, and areas of charred bone are often exposed. In the case of a cranial vault burn, damage to brain structures is possible, which is confirmed by clinical and instrumental (encephalography, CT) examination data. The development of paresis, visual and auditory disorders is also possible. In the long term, this category of victims may develop purulent intracranial complications - meningitis, meningoencephalitis, abscesses.
Unlike electrical burns, arc flame burns almost always affect exposed areas of the body (face, hands). The damage is always superficial and heals within 5-10 days.
Laboratory research
Electrical trauma changes the qualitative and quantitative composition of the formed elements of the blood: the phagocytic activity of leukocytes is steadily reduced, erythrocytopenia develops due to an increase in the rate of cell decay. In terms of biochemical parameters, the level of residual nitrogen, glucose, and bilirubin often increases, the albumin-globulin coefficient decreases, and disorders of the blood coagulation system are possible.
Differential diagnostics
In the early stages after injury, it is sometimes difficult to differentiate between an electrical burn and a deep flame burn resulting from clothing catching fire in a combined injury. In these cases, the cause of the injury is determined later in the treatment process.
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Indications for consultation with other specialists
In hospital, patients with electrical injuries require observation by various specialists (therapist, neurologist, psychiatrist) in the intensive care unit or intensive care ward.
Example of diagnosis formulation
Electrical injury. Electrical burn of III-IV degree of the left hand, 3% of the body surface. Flame burn of I-II degree of the face and right hand, 5% of the body surface.
Treatment of electrical injury
General treatment of electrical trauma is aimed at normalizing the functions of internal organs and body systems, preventing and treating infectious complications.
Indications for hospitalization
All victims who have suffered electric shock, as evidenced by loss of consciousness, the presence of current marks or more extensive electrical burns, are subject to hospitalization.
Non-drug treatment of electrical injury
It is important to know the principles of first aid in case of electric shock. The use of relatively simple measures can often save the victim's life and prevent injuries to those providing assistance. First of all, the effect of electric current on the victim should be stopped. In the case of low-voltage current (no more than 380 V), the switch should be turned off or the fuses on the distribution board should be unscrewed. You can throw the wire off the victim with a dry stick or cut the wire with an axe. It is safe to approach the victim. If a limb is "fixed" to a current-carrying wire, the victim should be pulled away from the source, using objects that do not conduct electric current (dry boards, rubber gloves). Assistance to victims of high-voltage current should be carried out in rubber shoes and gloves. In case of contact of electric wires with the ground, the victim should be approached in small steps, without lifting the soles from the surface or jumping on two tightly closed legs. Otherwise, the rescuer may also receive severe electric shock.
If the "apparent death" symptom complex develops, it is necessary to carry out a set of resuscitation measures: artificial respiration and indirect heart massage. Defibrillation is used in case of heart rhythm disturbances. Sometimes tracheal intubation or tracheostomy is performed for the most effective ventilation of the lungs. Infusion therapy is sometimes performed to stimulate cardiac activity and combat cerebral and pulmonary edema.
Medical treatment of electrical injury
It is advisable to treat victims with electrical burns in burn hospitals. The basic principles of infusion-transfusion therapy used in burn shock should be followed. The criteria for the volume and composition of media, the rate of administration and the duration of therapy should be such indicators as hemoconcentration, hemodynamic disorders, electrolyte and acid-base balance, and renal dysfunction. Infusion-transfusion therapy is also of great importance in other periods of the disease; it differs slightly from that in extensive thermal burns.
Surgical treatment of electrical injury
An indication for surgical treatment is the presence of electrical burns of III-IV degree.
Local treatment of electrical burns is carried out according to standard general surgical principles, taking into account the phases of the wound process and similar to conservative treatment of deep burns in thermal trauma, aimed at the fastest possible preparation of wounds for free skin grafting. Among the surgical methods of treatment are decompression necrotomy, necrectomy, osteonecrectomy, ligation of vessels along the length, amputation of the limb, opening of abscesses and phlegmon, autodermoplasty.
Unlike thermal injuries, electrical trauma significantly more often requires necrectomy with excision of deep tissues (muscles, tendons, bones), which prolongs the time of wound preparation for surgical closure. More often, there is a need for amputation of the limbs, often simultaneously with ligation of blood vessels along the length. In case of damage to the bones of the cranial vault, after excision of soft tissue necrosis, craniotomy is performed. For this purpose, multiple trepanation holes with a diameter of 1-1.5 cm are made in the dead bone using a milling cutter to the bleeding tissue. Such manipulation promotes wound drainage, reduces the time it takes to cleanse it from osteonecrosis, and prevents intracranial purulent complications. In addition, during craniotomy, the depth of bone damage is clarified. After 1.5-2 weeks, trepanation holes are made with granulations: either from diploe (in case of necrosis of only the outer plate), or from the dura mater or brain matter in case of total bone damage. After 1.5-2 months after the operation, the wound is completely cleared of necrotic tissue and covered with granulation tissue. Autodermoplasty is performed during this period.
In case of electrical burns of the extremities, preventive ligation of vessels is often indicated. Such an operation is necessary to prevent possible bleeding from eroded areas of the vascular wall in the burn zone. Ligation of vessels is performed above the site of injury outside the necrosis zone.
All types of modern skin plastic surgery are used to restore lost skin: free dermatomal, plastic surgery with local tissues and flaps on a pedicle, Italian and Indian plastic surgery, "Filatov stem". Non-free methods of skin plastic surgery are especially indicated for defects of soft tissues and skin in functionally active zones (joint area, supporting surface of the feet, exposed bones and tendons).
Possible postoperative complications
As with surgical treatment of deep thermal burns, the most common symptoms are melting of skin autografts and suppuration of donor wounds. When performing non-free skin grafting, suppuration of the surgical wound is not uncommon.
Further management
Timely and professional treatment of severe electrical burns in many cases does not save victims from the formation of cicatricial deformations and contractures, therefore, the majority of such patients in the long term require reconstructive and restorative surgical treatment.