Electrical burns in our workplace

INTRODUCTION

Electricity at this time is necessary for survival of human society. In case of misuse it can cause life-threatening situations for individuals or severe and mutilating injuries. The Department of Burns and Reconstructive Surgery of the Hospital Košice-Šaca provides medical services mostly to thermal injuries of the middle and eastern part of the Slovak Republic. The service includes treatment of electric injuries as well. This paper is a presentation of our 9-year experience with electric injuries in our country.

MATERIAL AND METHODS

There were 2320 patients hospitalised in our Burn Department in the Hospital Košice-Šaca from 1^st January 2004 to 1^st January 2013. 87 patients of these were admitted due to electric injury (3.75%). The review of patients according to years is presented in Chart 1. We divide the electric injury victims to the group of men, children up to 15 years of age and the group of women.

The patients were referred from various regions of our country. The levels of electric current up to 1000 Volts were considered as low tension injuries; 1000 Volts and higher were considered high tension injuries (1). In case the treatment started in our department, there were i.v. fluids administered according to Parkland formula with Ringer lactate or normal saline solution or according to updated Brooke Army formula after thorough examination of the patient In case of burnt children was fluid administration performed according to Galveston Shriners Burns Hospital formula. The flow rate of fluids was adjusted to correspond with the hourly diuresis of at least 1 ml/kg (2). If oedema with strangulation was present, escharotomy was performed at the time of admission or next day according to the clinical status. The aim of burn treatment was to provide time to spontaneous recovery of tissues. If there was non-viable tissue, we performed necrectomy and reconstruction of the skin cover with skin grafting or flap as soon as possible. In most serious cases of mutilating electric injuries we were forced to perform amputation to gangrenous limbs.

RESULTS

The majority of electric burns occurred to men – 67 cases (76.74%), 44 (65.1%) of which were low-tension injuries (less than 1000 Volts), and 23 (34.9%) were high-tension injuries. The mechanism of injury to the group of men was direct contact with the source of current in 36 cases (54.5%), electric arc injury in 26 cases (37.9%), ignition of clothes and subsequently flame in 4 cases (6.1%), lightning injury in 1 case (1.5%). The average age in the group of men was 36.6 years, the average extent of burn wound was 11.7 % of TBSA (total body surface area). 31 (45.45%) of electric burn cases in men were occupational injuries. In 12 cases there were other kinds of trauma associated with the burn (fractures of bones, laceration of the spleen, contusion of the kidneys, pneumothorax, brain concussion, fissure of the liver, lung contusion, lacerations and contusions over the body, etc.). 27 (40.9%) victims from the group of men were unconscious at the time of injury, 5 were artificially ventilated (7.57%). 3 patients (4.54%) from the group of men died (shock status − 80% of TBSA, extensive myocardial infarction – 31% of TBSA, heart insufficiency - fibrillation − 69% of TBSA).

The group of electric burns in children consisted of 18 cases (20.94%). 14 of them (77.8%) were low-tension injuries, 4 (22.2%) were high-tension injuries (more than 1000 Volts). The mechanism of injury to the group of children was contact with the source of electric current in 15 cases (83.4%), electric arc injury in 3 cases (16.6%), no ignition or lightning injury occurred in this group. The average age in the group of children was 5.83 years, the average extent of burn wound was 5.83% of TBSA. There was associated trauma in 3 cases (16.6%) (fractures, brain concussion, etc.). In 3 cases there was unconsciousness at the time of injury, no artificially ventilated child was present, no death occurred in the group of electric injury to children.

The group of electric burns to women consisted of 2 women, both were low-tension contact burns; the average age of patients was 51.5 years and the average extent was 2% of TBSA. There was no associated injury, no death occurred and no artificial ventilation was needed. In both cases there was unconsciousness; the accidents did not have an occupational character.

A total number of 102 surgical procedures were performed in 58 patients from the group with electric burns; 29 patients healed spontaneously. In the group of men, 41 needed some surgery (62.1%) and 26 healed spontaneously (37.9%). If surgery was performed, 55 procedures were skin grafts (67%), 17 were flaps (21%) and 10 procedures were amputations (12%, Chart 2). The average duration of hospital stay was approximately 14.96 days.

In the group of electric burns in children, 15 needed surgery (83%) and 3 healed spontaneously (17%). 12 procedures were skin grafts (66%), 3 procedures were flaps (17%) and 3 procedures were amputations (17%, Chart 3). The average time of hospital stay was 13.94 days.

In the group of women, 2 women underwent 1 procedure each (together 2 in this group), which was skin grafting. The average duration of hospital stay was 14.5 days.

DISCUSSION AND CONCLUSION

Electric injury is a common problem of modern world. Some authors (3) reported a 16.9% contribution of electric injuries of all hospitalised burn patients. There were 3.75% electric injury cases of all hospitalised burn patients in our department in the last nine years. The occurrence varies from year to year.

It is very important to educate the population as well as the health care workers about the first necessary measures that are needed in case of an electric injury. The safety of our homes, public spaces or workplaces is also a necessary measure in the aim to further reduce the incidence of these accidents.

Address for correspondence:

P. Lengyel, M.D., PhD

Department of Burns and Reconstructive Surgery

Hospital Košice-Šaca

Lúčna 57

040 15 Košice

Slovak Republic

E-mail: peterlengye@yahoo.com.au