Definition

Electrical injuries are a complex and potentially life-threatening type of trauma, linked to elevated rates of mortality and morbidity. These injuries can arise from lightning strikes or contact with low or high-voltage electric currents, resulting in physical or mechanical harm. Most electrical injuries happen suddenly and unexpectedly, often with The severity of electrical injuries hinges on factors such as the type of electrical current, voltage, and resistance encountered. Typically, direct contact with an electric current results in burns, a common manifestation of electrical injuries. Physical wounds stemming from electrical injuries can be fatal and cause death. In conditions when the injury is not considered to be severe, it could still lead to dysfunction across various bodily tissues and organs. 

In the United States, approximately 1,000 deaths annually are attributed to electrical injuries. From this figure, roughly 400 cases stem from high-voltage electrical incidents and an estimated 50-300 cases result from lightning strikes. Additionally, there are approximately 30,000 cases of non-fatal electrical injuries reported annually. Among these cases, approximately 20% occur in children, with the majority affecting adolescents. Although specific data for Indonesia is unavailable, similar trends are observed.

In adults, workplace-related electrical injuries are predominant, ranking as the fourth leading cause of traumatic deaths. Conversely, electrical injuries in children predominantly occur at home.

Causes

At home, individuals may sustain injuries from electric shocks, often resulting from contact with common household electrical appliances, extension cords, or power outlets. Typically, such incidents rarely lead to significant physical impairments or severe complications.

Children, particularly when unsupervised, are prone to experiencing low-voltage electric shocks. These injuries typically do not involve loss of consciousness or cardiac arrest. Additionally, adults may inadvertently encounter low-voltage electric shocks at home, especially when they are engaging with electrical appliances, such as installing lighting fixtures.

While low-voltage electrical injuries typically don't lead to severe consequences, prolonged contact with the electric current can escalate the severity of the injury, akin to high-voltage electrical injuries. Extended exposure to electric current may induce muscle tetany, causing muscular rigidity and potentially disrupting the heart's electrical rhythm.

In the workplace, approximately 50% of electric shock cases stem from contact with power lines, while around 25% result from interactions with machinery or other electrical equipment.

Risk factor

Identifying different risk factors is crucial for both preventing and addressing electrical injuries. Although anyone can be vulnerable to such injuries, certain factors can heighten the likelihood of experiencing electrical injuries in the future.

Here are some of the risk factors:

• Employment or engagement in activities involving the use of power tools
• Working outdoors in environments vulnerable to lightning strikes
• Being in open fields during active lightning storms
• Handling electronic systems without proper training or qualifications

Symptoms

Symptoms experienced during an incident of electrical injuries vary based on the voltage and duration of exposure. Common symptoms that could be experienced include:

• Intense muscle spasms
• Sensations of numbness or tingling
• Weakness or instability
• Burns 
• Headaches
• Vertigo
• Seizures
• Irregular heart rhythms

In severe cases, symptoms may progress to loss of consciousness or cardiac and respiratory arrest.

Diagnosis

The diagnosis of electrical injuries primarily relies on clinical assessment, wherein doctors ascertain the diagnosis through a comprehensive medical interview and physical examination, based on the manifestations of visible injuries. Nonetheless, certain diagnostic tests can aid in confirming the diagnosis, such as electrocardiogram (ECG) and complete urinalysis.

Given the specialized treatment required for electrical injuries, diagnosis must be conducted by a doctor. Patients should inform their healthcare provider of any prior electrical injuries. Providing details such as the onset of symptoms could assist doctors in diagnosing the condition and devising optimal treatment strategies during the initial evaluation.

Management

If you encounter a case of electrical injury involving another person, you can help by taking these first-aid steps:

• Safely deactivate the power source by unplugging the cable or turning off the circuit breaker, if feasible
• Call emergency services immediately to request medical assistance
• Use non-conductive objects like chairs to move the person away from the electric current, avoid wet objects or metals
• Assess the person's breathing and pulse once you are located far away from the power source
• Perform cardiopulmonary resuscitation (CPR) if the person is unconscious and you cannot feel their pulse

Complications

Complications frequently arise from wounds sustained in high-voltage electric shock incidents, primarily in the form of electrochemical or thermal damage to affected bodily tissues. Risks include protein denaturation, tissue necrosis, hemolysis (rupture of blood cells), and thrombosis (obstruction of blood flow).

Long-term complications stemming from electrical injuries may encompass seizures, impaired balance and coordination, neuropathy, tinnitus (ringing in the ears), cognitive difficulties, such as impaired focus or memory, elevated risk of depression, or post-traumatic stress disorder (PTSD).

Prevention

To prevent the occurrence of electrical injuries, consider the following preventive measures:

• Store power tools out of children's reach
• Utilize child-safety covers for electrical equipment
• Adhere to instructions diligently when operating power tools
• Refrain from using power tools in the bathroom 
• Deactivate all circuit breakers when conducting repairs on power tools

When to see a doctor?

To reduce the risk of serious physical complications resulting from burns caused by electric shock, it's crucial to seek immediate medical attention at the nearest healthcare facility. Upon arrival, it's advisable to undergo a thorough assessment by an emergency medicine specialist, surgeon, or plastic surgeon. 

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