History

The commercial development of electrical energy began almost 150 years ago and was followed closely by the occurrence of serious injuries and fatalities. The first death may have been in 1879 in Lyon, France.

At present, over 1000 deaths occur each year in the United States, and electrical burns account for about 4% of the admissions to burn units.

The spectrum of clinical problems that occur from injuries secondary to electrical current span the household current injury of the oral commissure in a child to superficial palmar burns from a higher-tension source to that of a lethal high tension injury. Anatomically, high-tension electrical injury is devastating regardless of the area involved, whether skull, abdomen, or extremity.

Classifications of the type of electrical burns usually list three: thermal, arc, and direct electrical injury. A division of high-tension electrical injury into two subgroups, flash and ‘true’ has been found, by the author, to be useful. This division is based on the observation that some patients, although in contact with a high-tension source, actually sustained a flash pattern of burns and have a clinical course substantially distinct from that of the ‘true’ group. A ‘true’ high-tension electrical injury has the classic clinical features of a well-demarcated leathery full thickness site of current entrance and exit, although the distinction between entrance and exit wounds is not always obvious.

Initial assessment and resuscitation

The initial assessment of the electrically injured patient should consider associated injuries sustained in a fall or other circumstances at the time of the accident.