However, the electric burns are made from the inside out. This makes electric burns different from other injuries, like thermal burns. Patients with severe injuries that are hidden internally will need medical treatment soon, even if they look stable. They are at great risk for amputations a few days after the electrical injury.
Muscle and bone can have such severe electrical burns that myonecrosis (muscle death) can be present and lead to patient death if not treated.
Airway in Electrocution
Many patients experience loss of consciousness at the time of electrocution so airway management is a priority for the EMT.
Electric Burns and Neurological
The heat created when electricity travels through the nerves can cause spinal cord quadriplegia injuries and even brain damage. Asystole and ventricular fibrillation is a possible result of electric burns, but did you know they can cause hypoxic encephalopathy in electrical injury patients?
For this reason, patients may experience long-term personality changes and mental status issues which never return to normal.
Vascular Damage
The patient can experience electrocution side effects as the current travels through the vascular tree and weakens blood vessels. Electric burns can cause thrombosis of arteries and lead to heart attack, stroke and pulseless extremities.
For this reason EMS should always check an electrical injury patient’s pedal pulses, even with patients who appear to have minor electrical burns. Patients with high voltage electrical burns can have vascular damage and will be at risk for rupture, aneurysm and delayed ruptures which can happen later on.
Here is a link to an interesting case study of a patient who experienced vascular damage and spontaneous rupture after high voltage electrical burns.
Electric Burns & Musculoskeletal
It’s common with severe electrical burns, especially a high voltage electrical injury, for muscles to contract rapidly. In fact, electrocution can cause muscles to contract so violently that patients can experience broken bones. Because of vigorous muscle contraction, shoulder dislocation is also a common injury from electric burns.
Tetany can also occur during electrocution and cause the patient to grab onto the source of electricity, prolonging the length of time they experience electrocution. While AC frequencies tend to cause tetany, DC tends to cause one contraction which can throw the patient away from the source of electrocution.
Patients that are thrown during electric burns can be victims of secondary blunt force trauma. These patients should be treated as multiple trauma victims because they are at risk for head injuries, neck fractures, and other trauma as a result of the explosive power of the electricity. For these reasons, patients with electric burns should receive a full body assessment.
Myonecrosis and Compartment Syndrome are serious electrocution side effects that can result after the event. As mentioned above, myonecrosis is muscle death caused by the electrical burn injury. It can result in amputations or even death if the patient doesn’t receive the needed treatments.
EMS must not underestimate the extent of occult muscle damage that may be present. The EMT should watch for signs of compartment syndrome, which are discussed in the electrical burn management section below.
Renal Injury
Electric burns, especially a high voltage electrical injury can have devastating effects on the kidneys and fluid balance of your patient. Patients can become hypovolemic, experience hyperkalemia and acute renal failure due to cellular breakdown in the body.
Another serious complication of severe electrical burns is rhabdomyolysis. EMTs at the basic level may not be familiar with the term so here is a very summarized explanation.
Rhabdomyolysis Summarized
When an electric shock injury occurs it can cause a lot of skeletal muscle injury. When skeletal muscle is damaged, the intracellular contents are released into the plasma at such high levels they become toxic to the body.
Ultimately, this will lead to too much myoglobin in the circulatory system which results in renal tubular obstructions, nephrotoxicity and acute renal failure. Tea colored urine is indicative of renal damage after an electrical injury and EMTs at the paramedic level will need to begin treatment for rhabdomyolysis in the field.
Electric Burns & Cardiac
Possible injuries from electric shock are myocardial necrosis, asystole, ventricular fibrillation and other dysrhythmias. A high voltage electrical injury is more likely to cause asystole and a low voltage burn is likely to cause ventricular fibrillation.
When the heart comes in direct contact with the electrical current that travels through the body, it increases the likelihood of cardiac muscle death, aka myocardial necrosis. Cardiac electrocution side effects are also more likely if the current travels through the body physically crossing the patient’s chest.
Pulmonary in Electrocution
Pulmonary electrocution side effects can be serious and even life threatening for patients. Electric burns that travel through the brain can cause the patient to go into respiratory arrest.
Patients also go into respiratory arrest due to prolonged tetany (muscle contractions) during an electric shock injury. The electrocution causes diaphragm and chest wall muscles to contract and the patient is unable to relax the chest wall muscles to breathe.
Sustained tetany can lead to respiratory arrest and the EMT will need to initiate CPR on these patients.
Other possible injuries from electric shock are lung injury or contusions from the electric blast or from being thrown.
Electric Burns: Ocular & Nasal
The EMT may experience patients that have dilated pupils after a high voltage injury. If other neurologic signs are as expected, you can assume the dilated pupils are a result of excessive catecholamine released from the electrical injury. Also, a long-term ocular effect of a high voltage electrical injury is delayed cataract formation.
Other possible injuries from electric shock are deafness and ruptured ear drums.
Electrical Burn Entry and Exit Wounds
Possible injuries from electric shock are electrical burn entry and exit wounds. An electrical injury can look very different from patient to patient. Some patients may have electrical burn entry and exit wounds, while some may not have an exit wound.
In fact, it’s possible for patients to have internal electric burns without showing electrical burn entry and exit wounds at all. When present electrical burns typically occur on the hands, fingers, face, and feet.
The severity of electrical burn entry and exit wounds can vary too. They can appear to be charred, black, white and yellow looking wounds. Exit wounds have the potential to be severe electrical burns that can be larger and “explode” out like gunshot exit wounds. (See below for sites to view electrical burns images.)
Electrical Burn Photos
There are no electrical burn photos here because they can be hard to look at for some people. I do want to give anyone who is reading this and interested a good place to find electrical burns images. If you have never had a patient with a serious high voltage electrical injury, it’s good to see the damage that electricity can do to the body.
I also recommend checking out some electrical burn photos because often they show the patient’s wounds days after the event took place.
The first site is Medscape and has about 20 electrical burns images. They are good medical photos of electric burns that can be found at the link below:
https://reference.medscape.com/features/slideshow/electrical-injuries
The link might ask you to register with Medscape in order to see the electrical burn photos. If you prefer not to do that, another option is to access the slide show through your search engine.
I’m able to google it by typing “medscape electrical injuries slide show” and then I can access the page without registering.
The second site I recommend for electrical burns images is an OSHA site. Along with each photo is a description of what happened and whether it’s and entrance or exit burn. Here is the OSHA electrical burn photos link.
Cont. below to Page 4
Christina Beutler is the creator of EMT Training Base. She is a former EMT and a current Registered Nurse. Christina’s path changed after taking a Basic First Aid class while in Community College, and a career in healthcare opened up. Working as an Emergency Medical Technician led to a passion for nursing and a job working in the Intensive Care Unit and Critical Care Unit right out of Nursing School. To learn more about Christina’s story, head over to the About page.
