Emergency Medicine

212 Environmental Emergencies

Electrical Burns, Electrocution and Lightning Strike

(d) give midazolam 0.05–0.1 mg/kg i.v., diazepam 0.1–0.2 mg/kg,

or lorazepam 0.07 mg/kg up to 4 mg i.v. for seizures

(e) refer the patient to a hyperbaric medicine unit, even after

apparent recovery, as delayed deterioration can occur and

recompression may still be required.

ELECTRICAL BURNS, ELECTROCUTION AND LIGHTNING STRIKE

Factors inf luencing the severity of electrical injury include whether the current is

alternating or direct, the resistance to current f low, voltage, the pathway of

current through the patient and the area and duration of skin contact.

Skin resistance is decreased by moisture which increases the current and the

likelihood of injury.

Electrica l injur y may be considered in four groups:

● Electrical flash burns.

● Low-voltage electrocution.

● High-voltage electrocution.

● Lightning strike.

Electrical flash burns

DIAGNOSIS

1 The external passage of current from the point of contact to the ground is

associated with arcing. Electrical energy is converted to heat as electricity

traverses the skin associated with brief high temperatures that may ignite

clothing.

2 Burns are usually superficial partial-thickness, but they may be deep dermal

or even full-thickness. Secondary f lame burns may occur if clothing ignites.

MANAGEMENT

1 Assess the depth and extent of the burn (see p. 251).

2 Check the eyes for evidence of corneal injury using f luorescein.

3 Dress the areas as for a thermal burn and treat accordingly.

Low-voltage electrocution

DIAGNOSIS

1 Injury primarily occurs in the home through faulty electrical equipment or

carelessness. Household voltage supply is usually 240 V alternating current

(AC).