Electrical injury

First aid algorithm and routing

Lifesaving begins with the immediate cessation of current exposure. The main rule is strict adherence to safety protocols, as touching the victim's body is fatal to the rescuer.

1. Disconnection: Turn off the switch, circuit breaker, or unscrew the fuses. If this is not possible, chop the wire with an axe or shovel featuring a wooden handle. You can also push the wire away using a dry stick or board. Using metal rods, wet rags, or bare hands is strictly prohibited.
2. Evacuation: The person may only be dragged by the edge of their dry clothing.
3. Resuscitation: If spontaneous breathing and heartbeat are absent, cardiopulmonary resuscitation (CPR)—chest compressions and artificial ventilation (mouth-to-mouth or mouth-to-nose)—must be performed immediately.
4. Local care: Dry aseptic dressings are applied to burn sites only after cardiac activity has been restored.
5. Transportation: Performed strictly in a horizontal position. Absolutely all victims are subject to urgent hospitalization in the intensive care unit (ICU).

Clinical presentation and "current marks"

Facial electrical burns have very specific visual manifestations. "Current marks" (electrical marks) form at the points of contact with the voltage source, the size of which depends on the contact area.

• Appearance: The affected areas are dry, shiny, whitish-grey or brown. They are well-demarcated and raised above the healthy skin surface, subsequently transforming into a dense scab.
• Symptoms: The contact burn surface is painless or exhibits mild pain. A complete lack of tissue edema and surrounding skin hyperemia is characteristic.
• Lightning strike: In this case, "current marks" take the appearance of characteristic branch-like red lines.

Pathogenesis and depth of injury

The main feature of an electrical injury is the discrepancy between visible external damage and the actual scale of destruction inside the tissues.

• Depth of necrosis: Electrical burns are generally deep. They affect the subcutaneous adipose tissue, muscles, and bones of the facial skeleton.
• Specifics: The area of underlying tissue destruction is always significantly larger than the local skin lesion area.
• Causes: This picture is due to the unequal electrical conductivity of tissues (facial skin has the highest electrical resistance, so most of the energy is released deeper) and developing circulatory disorders.
• Sloughing: Necrotic tissues slough more slowly compared to conventional thermal burns, and the affected areas themselves remain less painful.

Wound healing process and complications

The course of an electrical injury is accompanied by severe systemic and local reactions of the body.

• Intoxication: Signs of pronounced intoxication are observed, resulting from significant destruction of underlying tissues and the absorption of breakdown products.
• Infections: The burn wound itself is initially resistant to pyogenic microflora. However, if an infection joins, the process spreads deeper with the formation of severe purulent foci—abscesses and phlegmons.
• Vascular complications: There is a high risk of erosive bleeding from large vessels. This danger reaches its maximum at 3–4 weeks post-injury.
• Healing: Regeneration processes are drastically slowed due to marked trophic disorders in the affected area.

Class and exam questions

What else to study on this topic

• Technique of artificial lung ventilation and chest compressions during electrical injury.
• Mechanisms of pronounced intoxication development during massive destruction of muscle tissue.
• Surgical tactics in deep purulent complications (abscesses and phlegmons).
• Prevention of erosive hemorrhages from large vessels at 3–4 weeks post-injury.
• Features of trophic disorders and delayed regeneration in electrical burns.

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.