Electrocution

Pathophysiology
Extent of injury depends on:

amount of current that passes through the body duration of current tissues traversed by the current Although the extent of injury is most directly related to amount of current (amperage) often only the voltage is known. In general, low voltage causes less injury but voltages as low as 50V have caused fatalities

Clinical features
Tissue heat injury

currents > 1 A generate sufficient heat to cause burns to skin and internal tissues blood vessels and nervous tissue particularly susceptible

Cardiac effects

AC of 30-200 mA may cause VF currents >5 A cause asystole other arrhythmias may occur myocardial damage. ST and T wave changes. Global LV dysfunction may occur hours to days later, even with minimal ECG changes MI has been reported. Diagnosis difficult due to raised CK levels (including CK-MB) from extensive muscle injury

Skeletal muscle

tetanic contractions with currents >15-20 mA. Prevent voluntary release of source of electrocution may cause #s of long bones and vertebrae compartment syndrome is a common manifestation of electrical injury to a limb

Vascular injuries

thrombosis and occlusion with resultant ischaemia and necrosis affected limbs may require amputation

Neurological injuries

can be central or peripheral, and immediate or late in onset. spinal cord damage resulting in para- or quadriplegia can result from a current traversing both arms acute symptoms tend to resolve in comparison to the more ominous delayed onset symptomatology monoparesis may occur in affected limbs (median nerve is very susceptible), then ulnar, radial and peroneal. electrocution to the head can result in LOC, paralysis of the respiratory centre and late complications such as epilepsy, encephalopathy, and Parkinsonism. autonomic dysfunction can also occur, causing acute vasospasm or a late sympathetic dystrophy.

Others

acute renal failure due to rhabdomyolysis ruptured ear drum (high-voltage) cataracts may develop later associated injuries. Result of victim being thrown or falling or clothing catching fire

Microshock

above refers to macroshock, when current flowing through the intact skin and body passes through the heart. microshock occurs when there is a direct current path to the heart muscle pathway may include: a PA catheter, transvenous pacemaker wires current required to produce pathological effects is in the order of 60mA. can result from direct contact with faulty electrical equipment, or stray currents

High tension and lightning injuries

tissue damage usually due to generation of heat loss of consciousness usual in initial phase many survive and survival has been reported despite initial poor prognostic signs (eg fixed dilated pupils) immediate death is usually due to cardiac arrest (asystole>VF)

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Investigations

ECG, echo CT, EEG, nerve conduction studies X-rays of spine and long bones Hb, electrolytes CK and urine myoglobin arteriograms may help in decisions to amputate limbs

Management

treat burns (complete excision required) with fasciotomies amputation consider the possibility of traumatic injuries prophylactic treatment to prevent rhabdomyolysis induced renal failure large volumes of IV fluid often required supportive

Late complications

muscle fibrosis peripheral neuropathies loss of tissue from debridement joint stiffness reflex sympathetic dystrophy cataracts paraplegia quadriplegia subtle mental changes

Pregnancy

electrical pathway if often from hands to feet and therefore passes through the uterus high prevalence of fetal death. Other fetal complications include oligohydramnios and intrauterine growth retardation management includes cardiotocography, ultrasound and obstetric consultation