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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 22  |  Issue : 1  |  Page : 79-82

Clinico-etiological profile and outcome of electric burns at RLJH, a tertiary care centre of South India


1 Department of Surgery, Medicine, Vydehi Institute of Medical Sciences and Research Centre, Whitefield, Bangalore, India
2 Department of Medicine, Vydehi Institute of Medical Sciences and Research Centre, Whitefield, Bangalore, India
3 Department of Medicine, SDUMC, Kolar, Karnataka, India

Date of Web Publication15-Dec-2014

Correspondence Address:
Ambikavathy Mohan
Assocate Professor, Department of Surgery, VIMS and RC, Whitefield, Bangalore 66, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-653X.147013

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  Abstract 

Introduction: The incidence of electrical accidents has increased, due to use of electricity in the house hold, institutions and industries. Electrical injuries can cause extensive disFigurement to that of significant functional disability and sometimes can be fatal due to cardiac events and therefore the patients need to be closely monitored in an ICU set up. Management of electrical burns patient requires a team work of surgeons and physicians. Materials and Methods: This retrospective study was conducted between January 2007 and December 2012 in the Burn Unit of Sri Devaraj Urs Medical College, Kolar, Karnataka, a rural tertiary care center of South India, to assess the demography, degree of disability and loss of life due to electrical burn. Result: We had 47 patients of electric burns admitted in our center. Most of the accidents leading to the electrical burn injuries could have been prevented. Conclusion: Prevention is possible by increasing public awareness through primary education among the rural people and by taking adequate precautions such as the use of personal protective equipments (insulated gloves and footwear.) and following national electrical codes.

Keywords: Atrial fibrillation, electric burn, electric injury, medical management


How to cite this article:
Mohan A, Srinivasan K, Ashokan B. Clinico-etiological profile and outcome of electric burns at RLJH, a tertiary care centre of South India. Indian J Burns 2014;22:79-82

How to cite this URL:
Mohan A, Srinivasan K, Ashokan B. Clinico-etiological profile and outcome of electric burns at RLJH, a tertiary care centre of South India. Indian J Burns [serial online] 2014 [cited 2019 Jul 19];22:79-82. Available from: http://www.ijburns.com/text.asp?2014/22/1/79/147013


  Introduction Top


Electricity is very useful to mankind, and it can be dangerous if not carefully used. Since 1849, the maximum use of electricity is seen for commercial purpose. Electric burns can be caused by low-voltage or high-voltage currents. The intensity of electric burn depends on the voltage, current flow and tissue resistance. [1],[2],[3] The damage caused by electric burn is based on three mechanisms, the local generation of heat causing coagulative necrosis of the cells and that due to direct passage of current causing disruption of cell membrane leading to cell death and tissue loss and injuries caused due to fall following electric shocks. The burns may vary from first degree to third degree depending on the duration of time the victim was in contact with the current.


  Materials and methods Top


This study was conducted in R.L. Jallappa Hospital (RLJH) from January 2007 to December 2012. Forty-seven (19.67%) patients were admitted with electrical injury and treated by surgeons and physicians, ten patients (21.27%) were in the age group of 21-30 years and in above fifty ten (21.27%), followed by five in 0-5 (10.6%), seven in 11-20 years (14.8%) eight in 31-40 (17.02%) and seven in 41-50 (14.8%) [Table 1] and [Figure 1]. The various types of electrical burns were accidental in nature with extremity injuries. Fourteen patients (29.21%) had electrical injury while working with irrigation pump motors and ten (21.27%) by contact with domestic current in the kitchen, seven (14.81%) due to contact with live wire, four (8.5%) sustained electrical burns, while working on electric pole, had a fall from height with multiple rib fractures and hemopneumothorax for which intercostal drainage was inserted and monitored for respiratory failure in the icu, six each (12.76%) were due to earthing/rain and contact with housing current [Table 2] and [Figure 2]. Skin grafting was done in 25 patients and ten underwent fasciotomy and all 30 patients settled well with local debridement and twenty six with disarticulations, three required fore foot amputations and two fore head flap rotation due to head injury with loss of scalp and two required intercostal drainage for rib fractures with pnueumothorax [Table 3] and [Figure 3]. We had one patient (2.1%) of acute renal failure settled with dialysis, ten patients developed septicemia and responded well to appropriate antibiotic therapy. Two patients (4.2%) had respiratory failure and were managed with ventilator care, eight (17.02%) developed atrial fibrillation and were treated by physicians in the intensive care unit with metaprolol and reverted to normalcy. Six (12.7%) had wound infection and did well with conservative management [Table 4] and [Figure 4]. There was no loss of life in electrical burns patients in our set up.
Table 1: Distribution of patients according to age

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Table 2: Distribution of various causes of electrical burn injuries

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Table 3: Various surgical procedures performed

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Table 4: Complications seen in electric burn patients

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Figure 1: Bar graph showing distribution of burns patients according to age group

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Figure 2: Bar graph showing various causes of electric burns

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Figure 3: Bar graph showing various surgical procedures performed in burns patients

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Figure 4: Graph showing complications seen in burns patients

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  Discussion Top


Electrical injury is different from other burns because of extensive local destruction of tissue at the points of entrance and exit. In our study, the percentage of burns estimated was between 10% and 30% superficial to deep burns ranging from first degree to third degree. There were 30 patients in our set up who required extensive wound debridement/escharotomy initially and revision debridements and ten fasciotomies of the extremities to avoid further damage followed by debridements and regular dressings [Table 3]. Artz described electric burns as severe muscle crush injury; Hunt showed that the deep-tissue loss is secondary to extremely high temperatures from resistance of the skin and bone to the passage of electric current. Joule's equivalent explains the heat exchange in thousands of degrees of centigrade; it is usually the voltage that can be determined and probably is the most important factor. High tension >1000 volts and low tension <1000 volts and direct and indirect currents all exert variable effects. [1],[2],[3]

Arc burns can occur without the patient contacting the electrical source but can be quite destructive. Electrical injury can affect many organ systems, depending on the path of the current. The volume conductor theory explains why extremity burns are much worse than torso burns and why extensive debridement is usually necessary. [4],[5],[6] We had 26 patients with finger and toe injuries caused due to contact with live wire and domestic current and motor pump shock injuries leading to amputations and disarticulations, three patients underwent disarticulation of toes initially but required fore foot amputation as a second stage due to extensive tissue and bone destruction [Table 2], [Table 3] and [Table 5] and [Figure 5]. The progressive destruction of tissue is best explained by small vessel occlusion and also by elevated levels of arachidonic acid in areas of greatest heat production. Acute cardiac events such as atrial fibrillations can occur and therefore patients are to be admitted under supervision of physicians in the intensive care unit and cardiac monitored to avoid loss of life. We had eight patients who developed atrial fibrillations during treatment for electric burns in the first 48 h and reverted to normal with timely medication [Table 4]. Atrial fibrillations are known to evolve during the first twenty four to 48 h called as the crucial period as atrial fibrillation though self-limiting, at times may turn fatal in the absence of proper monitoring. [3] Resuscitation must be aggressive to provide adequate circulatory volume. We had one renal failure patient who did well with dialysis. Normal vital signs should be maintained along with a urine output of 100 ml/h to overcome the destructive renal tubular effect of myoglobin and hemoglobin products. There were six patients with wound infection and ten patients with septicemia in our set up which was due to poor nutrition and anemia [Table 4]. Thorough and repeated wound debridements, correction of anemia and improving nutrition helped our patients to recover well. We had two patients with multiple rib fractures sustained from the fall from the electric pole due to the electric contact during repair work and required intercostal drainage; respiratory failure was managed with ICU and ventilatory support and they recovered [Table 3] and [Table 4]. Superficial skin grafting was done in 25 patients while two had fore head rotation flap with good outcome. There were no deaths due to electric burns in our study. Control of sepsis and its complications through aggressive wound management is critical for survival. [7],[8],[9] There was fall in the number of electric injury patients noted in our study from 39.91% in 2010 to 14.89% in 2012 [Table 6] and [Figure 6], although the exact cause is not known, we presume that our counseling/education of patients towards use of safety measures could have brought a change by way of word to mouth in the villages or there is a possibility of cases being treated elsewhere.
Table 5: Amputations performed in electric burn patients

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Table 6: Yearly distribution of electric burn patients
admitted to R.L.Jallappa Hospital burn unit


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Figure 5: Bar graph showing amputations/disarticulations performed inclectric burns patients

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Figure 6: Pie chart showing year wise distribution of electrical burns patients

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To bring down the incidence of electrical burns and safe guard human lives it is worthwhile to educate and train our rural people and those working with electricity regarding the National Electrical Safety Codes such as:

1. Use of color coded wiring, safety model circuits and volt regulating equipments.

2. Locking out and tagging out of circuits.

3. To put off energy source/power before repairs.

4. Avoid inadequate wiring, exposed electrical wires, wet conditions, overloaded circuits and damaged tools/equipments.

5. Ensure good earthing and insulation techniques.

6. Training in use of personal protective equipments, First aid safety measures, emergency medical services, awareness of fire extinguishers and cardio pulmonary resuscitation.


  Conclusion Top


Since ours is a rural area where most of the occupation is agriculture, the electric burns by accidents are common. Hence creating awareness, education and following of safety measures like use of insulated gloves and footwear play a key role in prevention. Electrical burn patients need to be monitored and treated for cardiac events in the first 48 h. As disability from electrical injury is a possibility, efforts for rehabilitation and counseling should be a part of our treatment protocol.

 
  References Top

1.
Sachade J, Shaikh MF, Suri M, Kapadia K, Agarwal S. Electric burns. A two year study. Indian J Burns 2008;16:19-23.  Back to cited text no. 1
    
2.
Handschin AE, Vetter S, Jung FJ, Guggenheim M, Künzi W, Giovanoli P. A case-matched controlled study on high-voltage electrical injuries vs thermal burns. J Burn Care Res 2009;30:400-7.  Back to cited text no. 2
    
3.
Kumar S, Ambikavathy M. Atrial fibrillation due to low tension electric shock. A case report. J clin Biomed Sci 2013;3:1  Back to cited text no. 3
    
4.
Mohammadi AA, Amini M, Mehrabani D, Kiani Z, Seddigh A. A survey on 30 months electrical burns in Shiraz University of Medical Sciences Burn Hospital. Burns 2008;34:111-3.  Back to cited text no. 4
    
5.
Haddad SY. Electrical burn - a four-year study. Ann Burns Fire Disasters 2008;21:78-80.  Back to cited text no. 5
    
6.
Chandra NC, Siu CO, Munster AM. Clinical predictors of myocardial damage after high voltage electrical injury. Crit Care Med 1990;18:293-7.  Back to cited text no. 6
    
7.
Varol E, Ozaydin M, Altinbas A, Dogan A. Low-tension electrical injury as a cause of atrial fibrillation: A case report. Tex Heart Inst J 2004;31:186-7.  Back to cited text no. 7
    
8.
Akdemir R, Gunduz H, Erbilen E, Ozer I, Albayrak S, Unlu H, et al. Atrial fibrillation after electrical shock: A case report and review. Emerg Med J 2004;21:744-6.  Back to cited text no. 8
    
9.
Bøggild H, Freund L, Bagger JP. Persistent atrial fibrillation following electrical injury. Occup Med (Lond) 1995;45:49-50.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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