An electrocution injury is an injury one sustains when exposed to a large electrical current, such as lightning, a power line, or other source of electricity. They can be low voltage injuries or high voltage injures. The injuries depend on the amount of current going through the body and from the conversion of electrical energy into thermal energy or heat. There are also many secondary effects from current traveling through the body. The severity of the injury depends on the voltage that passes through the person, the type of current being applied and how long the person is exposed to the current. Some tissues are more resistant to electricity than others and there is sometimes a large amount of current applied to a large surface area and sometimes an amount of current applied to a small surface area of the body.
DC current is also called direct current. An electrical current applied using DC current involves muscle contraction that throws the person free of the electricity but can also cause blunt force trauma due to the fall of being thrown from the current. Direct current injuries are more likely to cause cardiac arrhythmias, depending on the phase of the heart that the heart is in when the electrical current occurs. Electricity acts like a defibrillator to the heart, altering its rhythm.
In AC current, or alternating current, the voltage is low but the electrocution is much more severe and dangerous. In fact, AC current is three times more dangerous than DC current. When AC current occurs, the muscle goes into tetany so the victim remains at the site of the electrocution and cannot let go. This increases the duration of the exposure to the electricity and makes the damage to the muscles and organs that much greater.
More tissue damage happens the longer the person is exposed to the current, especially if the voltage is quite high. The current becomes concentrated at the ground points of the body and at the spot where the electricity comes into the body. The most tissue damage happens between the point of contact and between the point of grounding. There is in effect a pathway of damage from these two points.
There can be direct contact between the person and the electricity or indirect contract, such as when an arc occurs between the electricity and the individual. Other injuries can occur with an electrical flash or with blunt trauma occurring in DC-type injuries. An arc is the worst injury possible because the temperature is very high, sometimes as high as 2500 degrees C. Clothing can burn and there are severe burns likely. Bones can be fractured from tetany or from being thrown from the source. Flash burns can burn clothing and can cause partial thickness burns. CNS symptoms are common because of blunt force trauma to the brain and skull. Cataracts can be instant or can develop over time. Five percent of those who have had an electrical injury to the head go on to have cataracts. Other eye injuries, such as corneal burns, are common as well.
Other common areas of electrical trauma are the mouth, especially in infants who suck on an electrical source. Lungs can be damaged, the solid organs of the abdomen can be damaged, and the kidneys can fail due to rhabdomyolysis from muscle breakdown. The long bones can be fractured easily and there can be compression fractures to the vertebrae. Dislocations of the scapula and the shoulder can happen during tetany. Usually the CNS damage is transient but there can be lasting effects. It is common to have long term disability, especially if the CNS damage is permanent. Sometimes there can be amnesia of the event or even change in level of consciousness, including coma. The spinal cord can be damaged in an electrical injury so that the person has paralysis or muscle weakness. The injury to the spinal cord can be direct or indirect and the paralysis can be temporary or permanent. The skin is often involved but does not predict the degree of internal damage that has occurred.
The treatment of electrical injury is involved with taking care of airway, breathing and blood circulation. The person should be considered to have trauma until proven otherwise. The amount of myoglobin in the blood can tell how much muscle damage has occurred. The individual must be given considerable fluids to flush out the myoglobin. Injuries such as crush injuries or fractures should be managed as in non-burn injuries. The urine output should be kept at fifty to seventy five cc per hour or even double that in order to protect the kidneys from damage. Lasix is sometimes used to help improve kidney output.