PEDIATRIC SURGERY UPDATE ©

VOLUME 51 NO 04 OCTOBER 2018

Electric Burns

Electrical burns and injury are the third most common cause of burns after scald and flame injury. The population most prone to electrical injury is young children and teenagers. In children, the injuries tend to occur in the household. In adolescents, they are most often associated with misguided youthful exploration outside the home.  Electrical current can reach deep tissues and cause extensive deep injury to tissues including nerve, bone, tendon tissue, muscle and skin. The injury caused by electrical burns depends on the magnitude of the electric current, the duration of exposure and the resistance of the tissue involved. They are classified as high voltage when above 1000 volts or low voltage if it's less. The morbidity and mortality in cases of high voltage injury are significant. Most cases involve males. Hospitalization is longer for children with high-voltage burns. Electrical burns accompanied by trauma are the result of falls from height. Once the child arrives at the ER an assessment of total body surface area compromised should be done and hydration according to Parkland formula instituted. Cardiac rhythm and renal function should also be examined with appropriate labs (myoglobinuria, BUN, serum creatinine, CPK, etc). Clinical parameters such as the mechanism of injury, voltage, burn size and depth, gross urine color and myoglobinemia can be easily used to predict and estimate the muscle damage. Myoglobulin and hemoglobin pigment in the child urine present risk of acute renal failure and must be cleared promptly.  Wound dressing should be done daily and wound debridement, tangential excision and grafting performed when necessary. Since it's difficult to asses internal damage the child is observed closely for signs of compartment syndrome and escharotomy or fasciotomy performed as needed. Gadolinium-enhanced MRI has demonstrated potential viability in zones of tissue edema with good correlation with histopathology of the lesion. Wound complications and infections are associated with electrical burns with Pseudomonas, Acinetobacter and Escherichia coli leading the organism spectrum. Intravenous antibiotics are essential component of management. Sepsis and renal failure are a common cause of late death. Electrical burns are associated with complications including orthopedic injury, amputation, and sensory and neuropsychiatry disturbances. They reduce cardiopulmonary functional exercise capacity to a greater degree than flame injuries.

References:
1- Kurt A, Yildirim K, Yagmur C, et al: Electrical burns: Highlights from a 5-year retrospective analysis.  Ulus Travma Acil Cerrahi Derg. 22(3):278-82, 2016
2- Hundeshagen G, Wurzer P, Forbes AA, Voigt CD, Collins VN, Cambiaso-Daniel J, Finnerty CC, Herndon DN, Branski LK: The occurrence of single and multiple organ dysfunction in pediatric electrical versus other thermal burns. J Trauma Acute Care Surg. 82(5):946-951, 2017
3- Foncerrada G, Capek KD, Wurzer P, Herndon DN, Mlcak RP, Porter C, Suman OE: Functional Exercise Capacity in Children With Electrical Burns. J Burn Care Res. 38(3):e647-e652, 2017
4- Arasli Yilmaz A, Kaksal AO, Azdemir O, et al: Evaluation of children presenting to the emergency room after electrical injury. Turk J Med Sci. 45(2):325-8, 2015
5- Alemayehu H, Tarkowski A, Dehmer JJ, Kays DW, St Peter SD, Islam S: Management of electrical and chemical burns in children. J Surg Res. 190(1):210-3, 2014
6- Roberts S, Meltzer JA: An evidence-based approach to electrical injuries in children. Pediatr Emerg Med Pract. 10(9):1-16, 2013

      Suicide

*Edited by: Humberto Lugo-Vicente, MD, FACS, FAAP
P.O. Box 10426, Caparra Heights Station, San Juan, Puerto Rico 00922-0426
Tel (787)-999-9450 Fax (787)-720-6103 E-mail: TITOLUGO@COQUI.NET
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Pediatric Surgery Update ISSN 1089-7739
Last updated: November 2018