Types and treatment of electrical injuries in children and adults. Electrical trauma and electrical burns: pathogenesis, clinical picture and treatment Doctors divide local burns by stages of progression

Electric shocks most often occur due to direct contact with a live conductor or through an electric arc formed as a result of ionization of air between a person and a source of electricity.

Electric current spreads predominantly through tissues with high electrical conductivity (blood, cerebrospinal fluid, muscles); dry skin, bones, and adipose tissue have the lowest electrical conductivity.

Electrical trauma refers to local and general changes in the body caused by the action of electrical energy. In the structure of traumatic injuries to humans, electrical trauma is rare - 1-2.5% of all mechanical injuries. The frequency of deaths from electric shock is 10% (Paramonov B.A., Porembsky Ya.O., Yablonsky V.G., 2000).

There are several options for injury from technical electricity.

In direct contact with an electrical conductor.

Contactless. Through arc contact in case of high voltage electric shock.

“Step voltage”, which arises due to the potential difference between two limbs touching the ground near a wire lying on the ground.

Electrical burns due to exposure to electric current occur because electrical energy is converted into heat and at the same time significantly damages tissues and organs. Moreover, tissues with high resistance - skin and bones - are most affected.

The direction of propagation of electric current is often hidden. There is such a thing as “the path of electric current through the human body”; the most dangerous are those that pass through the heart. In this case, myocardial fibrillation occurs. Burns spread deep into the tissues like a “funnel” or “iceberg”, when the visible part of the burn is much smaller in size than the invisible one. Electric current marks are found on the skin. A functional examination may not reveal the exact location and severity of damaged tissue.

Electrical trauma is characterized by a “latent” period of clinical manifestations, slow rejection of necrotic tissue, inhibition of regenerative processes, foci of osteolysis in the bones, as well as the absence of inflammatory changes around the sites of current application (burns) (Negovsky V.A., 1977).

Clinical observations show that in case of sudden death of a healthy person, resuscitation measures can be effective even 8-10 minutes after the onset of cardiac fibrillation or respiratory arrest (Negovsky V.A., 1977).

The inclusion of a person in an electric current circuit can be single- or double-pole. A single-pole connection is more common, when the victim touches one pole. Single-pole connection to a circuit without grounding is not dangerous. A two-pole connection involves the victim touching two sources of electric current. With this connection, the outcome of the injury depends on the path of electric current through the victim’s body.

There is a unique form of electric shock to a person called “step voltage”. Step voltage is a type of electric shock that occurs when a person falls into an “electrical crater.” An “electric crater” is formed when the soil is electrified when a broken wire from a high-voltage transmission line comes into contact with it. Electric shock occurs when a person moves across the concentric lines of an “electric crater.”

The wider a person’s step, the greater the potential difference between the person’s support points, i.e. soles and the stronger the effect of electricity. Therefore, in the “electric crater” it is necessary to move at a “goose step”, i.e. so that the toe of the shoe of one foot touches (on the ground) the heel of the other foot. It is safer if a person moves at an acute angle to the concentric lines of the crater.

The damaging effect of electric current depends on its physical characteristics, as well as the conditions of contact and the properties of the victim’s body. The physical characteristics of current consist of its strength, voltage, frequency and type.

Current strength. A current becomes dangerous to human life when its value is equal to or exceeds 0.1 A. The determining factor on which a person’s electric shock depends is the electrical resistance of the human body, which forms the magnitude of the flowing current and the intensity of energy absorption. The electrical resistance of the human body, mainly the skin, is influenced by many factors: skin moisture, its integrity, the state of nerve conduction, environmental humidity, time of year, etc. Dry skin has the greatest resistance; moisturizing it reduces the resistance many times, which increases the strength of the current passing through the human body, and hence its danger to the life of the victim. Depending on the current power (voltage), electrical injury can be divided as follows.

High voltage, voltage is above 1,000 W.

Ultra-high voltage, tens and hundreds of kW (Paramonov B.A., Porembsky Ya.O., Yablonsky V.G., 2000; Petrova I.F., Petrov N.V., Toryanik E.N., 2000).

Currents, the strength of which reaches 25-80 mA, can, with sufficient exposure, cause acute electrical asphyxia. The greatest danger to life is caused by currents of more than 100 mA, which cause the cessation of coordinated contractions of the heart and the onset of fibrillation.

High voltage currents cause fatal injuries in a smaller percentage of cases than low voltage currents. At high voltage, the respiratory apparatus is mainly affected.

Alternating current is much more dangerous than direct current. As the voltage increases, the damaging power of direct current increases. A current with a frequency of about 50 Hz is most dangerous in relation to the development of ventricular fibrillation, a current with a frequency of about 200 Hz causes respiratory arrest.

The duration of exposure to current has a very unfavorable effect on the outcome of treatment.

Tetanic contraction of the respiratory muscles occurs when current passes along the body. At the moment the current closes, a strong exhalation occurs, since the exhalation muscles are stronger than the inhalation muscles. At a current value of 15-25 mA, convulsive muscle contractions occur, which become so strong that the victim is unable to independently disconnect from the current-carrying object (the phenomenon of “non-releasing current”). Currents reaching 25-80 mA (with sufficient exposure) can cause acute electrical asphyxia. Transbulbar current passage can cause spasm of the glottis.

When current passes through the heart, various dysfunctions of excitability and conductivity occur, the nature of which is determined by the physical parameters of the current and the time of its exposure.

Cardiac arrest due to electrical trauma is not always associated with ventricular fibrillation, but can be caused by irritation of the vagus nerve (Negovsky V.A., 1977).

Thus, voltages up to 40 V usually do not cause fatal injuries to humans. Fatal and severe injuries are most often observed when exposed to household electric current. Its voltage is 127-220 V and its frequency is 50 Hz. Industrial three-phase electric current with a frequency of 50 Hz causes severe electrical injury.

When a low-voltage (up to 1,000 V) current passes through the human body, death most often occurs due to the development of cardiac fibrillation.

High voltage currents (over 1000 V) have a pronounced calorific effect at the points of contact, which leads to electrical burns.

Low-voltage (up to 500 V) alternating current is more dangerous for humans than direct current; above 500 V, direct current is more dangerous. The most dangerous for humans is the action of alternating current with a frequency of 50 Hz (domestic current), which causes cardiac fibrillation.

For the occurrence of electric shock, the paths through which it passes through the human body, the so-called “current loops,” are of great importance. The most dangerous is the “current loop” that passes through the heart, for example: left hand - left leg or hand - hand.

The most severe consequences occur when current passes from one hand to the other, from the left hand or from both hands to the legs, from the head to the arms or legs.

Clinical manifestations exposure to electric current is divided into general (electrical trauma) and local (electrical burns). Often they are combined.

Loss of consciousness (short-term or deep and prolonged), cyanosis, hypotension are possible, and blood pressure often increases due to vascular spasm. With a sharp depression of cardiovascular activity and respiration, victims sometimes give the impression of death (“imaginary death”). This condition is usually reversible with timely resuscitation. In some cases, when a victim loses consciousness, he is unable to tear himself away from the current-carrying conductor, and when falling from a height, he receives mechanical injuries of varying severity.

Electrochemical and mechanical effects are of some importance. When exposed to very high voltage currents, damage can occur in the form of tissue separation and even separation of limbs (explosive action of an electric discharge). Due to convulsive muscle contractions, avulsion and compression fractures of bones are possible.

Electrical burns are almost always deep (III B-IV degrees). Tissues are damaged at the points of entry and exit of current, on the contacting surfaces of the body along the path of the shortest passage of current, sometimes in the grounding zone. The affected tissue is usually represented by a dry scab, as if pressed in relation to the surrounding intact skin. Secondary tissue death is possible due to spasm and thrombosis of blood vessels, including main ones. The process of rejection of dead tissue takes a long time due to the great depth of the lesion (necrosis of muscles, tendons and even bones). Purulent complications often develop.

Electrical burns are often combined with thermal burns, caused by an electric arc flash or ignition of clothing. Such burns are characterized by sooting and metallization of the burned areas as a result of “spattering” and combustion of small metal particles of conductors. Mostly exposed parts of the body (face, hands) are affected, and the burns are usually superficial, but when clothing ignites, they are usually deep.

When the human body is damaged by electric current, its specific and nonspecific effects are distinguished. Specific types of current effects include biological, electrochemical, thermal and mechanical. Nonspecific types of current effects include the impact of a bright flash (voltage arc) on the organs of vision, ruptures of hollow organs, bone fractures due to convulsive muscle contractions, etc.

The biological effect of the current is that, having an effect on nerve receptors and body tissues, it causes myocardial fibrillation, causing tonic muscle contraction, disrupts the function of external respiration, arterial hypertension, etc. The electrochemical and thermal effect of current is that electrical burns occur, primarily at the points of entry and exit of electric current as it passes through the human body, primarily the skin and bones. As for the mechanical effect of current, it consists in the delamination and rupture of tissue due to the rapid release of a large amount of thermal energy when high voltage currents pass through human tissue.

The clinical picture of the injury has a peculiar character, which lies in the fact that the passage of electric current through the human body causes general disturbances and local tissue changes. Both the timing of development and the severity of these disorders may vary. For example, the death of victims may be instantaneous, or may occur several days after the injury. Exposure to high-energy electric current, especially in cases of severe burns, may not cause the death of the victim. But the leading symptoms in the clinical picture of electric shock are disorders in the cardiovascular and respiratory systems. These are myocardial fibrillation, atrial fibrillation, ischemic changes in the myocardium up to necrosis. The severity and outcome of electrical injury largely depend on the general condition of the victim, his age, the presence and severity of concomitant pathology.

Among the local manifestations of electric shock, electrical burns prevail, which, depending on the voltage, can be of varying depths, but rarely (in their pure form) occupy a large area. Basically, the lesion extends to the entire thickness of the skin and subcutaneous fat in the form of a funnel, i.e. The deeper the burn, the larger tissue masses it affects. This phenomenon is also called the iceberg phenomenon. The passage of electricity through the limbs is sometimes accompanied by damage to the neurovascular bundle, which often forces further amputations. Electrical burns to the head are the most severe due to the fact that the small amount of soft tissue and high resistance of the skull bones create conditions under which high-voltage currents cause fourth-degree burns. In case of electrical burns, the skin of victims is often found on the skin of various colors, from white to black, callus-like formations with a depression in the center, which in shape correspond to current-carrying contacts, the so-called “current marks”.

Currently, due to the lack of a unified classification of electrical injuries, a classification is used in practice, which takes into account four degrees of injury severity (Quoted from Paramonov B.A., Porembsky Ya.O., Yablonsky V.P., 2000):

I degree - short-term convulsive muscle contractions without loss of consciousness;

II degree - convulsive muscle contraction with loss of consciousness, but preserved breathing and cardiac function;

III degree - loss of consciousness and disturbance of cardiac activity or breathing (or both);

IV degree - instant death.

Urgent Care in case of electric shock, the fact is that performing relatively simple measures in the first minutes after an electrical injury can often save the life of the victim. The main condition for providing assistance is to cut off the power to the victim, i.e. stop the effect of electric current on a person by turning off the current, or drag the victim away from the current-carrying object in compliance with all rules and precautions (according to the instructions). In all cases of the development of clinical death, including the “state of imaginary death”, which for a layman is no different (outwardly) from clinical death, it is necessary to carry out a set of resuscitation measures for 40-45 minutes (preferably until spontaneous breathing appears), or until cadaveric spots (if resuscitation measures are ineffective). In cases of disturbance of the rhythmic activity of the heart, electrical cardioversion or defibrillation is mandatory; in the absence of a defibrillator, resuscitation measures must begin with mechanical defibrillation, i.e. precordial stroke.

In cases of a positive outcome of resuscitation measures, patients must be hospitalized for 3 days with bed rest, regardless of the severity of the injury, unless there is a need for treatment of local manifestations of electrical injury. The presence of neurological and psychopathological consequences of exposure to electric current in victims requires observation or consultation of specialists in various fields (therapists, neurologists, etc.).

Electrical injuries account for 2 - 2.5% of all traumatic injuries, however, a large percentage of mortality and disability due to electric shock puts them in one of the first places in importance (ICD-10 - T75.4 - exposure to electric current).

Industrial and household electrical injuries occur mainly under the influence of voltage currents from 127 before 380 B. These electric shocks are more often fatal due to the fact that they cause fibrillation of the ventricles of the heart, while high voltage currents cause large burns. Due to the good electrical conductivity of nervous tissue, the nervous system is most affected in the human body. The severity of the injury depends on: the strength of the current, the voltage of the current, the duration of exposure to the electric current, the state of the body during the electrical injury (fatigue, intoxication, increased skin moisture enhance the effect of the electric current).

Pathomorphology. A histological examination of the nervous system of those killed after electrical trauma reveals swelling of the soft shell of the brain, vasoconstriction, vasoparesis, pinpoint hemorrhages, plasma sweating, ruptures of vascular walls, swelling, tigrolysis, deformation and shrinkage of nuclei, destruction of nerve cell processes, in some places neuronophagia and cell death. Depending on the duration of exposure and the strength of the electric current, functional-dynamic shifts first occur in the nervous tissue, which can lead to permanent structural changes.

Pathogenesis of electrical trauma. First of all, electric current affects the autonomic nervous system. As a result, vasomotor disorders develop, leading to secondary changes in the nervous tissue - ischemia, necrosis. In addition, electric current has a direct effect on nervous tissue, causing ultramolecular shaking of the cytoplasm and displacement of ions. As a result, biodamage potentials arise, which cause further damage to the nervous tissue and the formation of various pathophysiological changes. Electric current also has a pathological effect on the nervous system through a reflex pathway.

Clinical picture. Depending on the nature of the clinical symptoms and the intensity of their manifestation, four degrees of electrical injury are distinguished:

I. first degree is characterized by the development of convulsive muscle contractions without loss of consciousness. All patients in such cases note a feeling of tension and muscle stiffness, difficulty breathing due to contraction of the respiratory muscles;
II. second degree is characterized by convulsive muscle contraction and loss of consciousness;
III. third degree is manifested by loss of consciousness, impaired cardiovascular activity and breathing;
IV. fourth degree- clinical death.

In grades I and II, symptoms of increased intracranial pressure, neurological and mental disorders may occur. Damage to the nervous system is usually detected immediately after an electrical injury, but sometimes signs of damage to the nervous system appear some time later. Typically, a person exposed to electrical trauma loses consciousness, and motor, sensory and reflex functions are completely shut down, i.e., a state of shock develops. A fall can cause a head injury. Therefore, the picture is often aggravated by signs of traumatic brain injury. The strong psycho-traumatic effect of electric current is also important. Once consciousness is restored, agitation, confusion, retrograde amnesia, headache, and even seizures are possible; then complete recovery occurs. Also, loss of consciousness may be delayed or recurrent, representing in these cases probably vasodepressor syncope.

For comatose state, caused by exposure to man-made electricity, is characterized by respiratory depression up to its complete stop and collapse. The latter is associated with both ventricular fibrillation and paralysis of the vasomotor center, as well as a decrease in circulating blood volume. Victims may experience repeated tonic and clonic convulsions, shock and renal failure. After emerging from a comatose state, prolonged lethargy, adynamia, and retrograde amnesia are noted. Cerebrospinal fluid pressure is often elevated, and subarachnoid hemorrhages are possible.

If the victims can be brought out of the state of shock, then a wide variety of lesions are found on the nervous system:

Electrotraumatic encephalomyelosis, which is characterized by diffuseness and multiplicity of symptoms - mental disorders, cerebellar symptoms, paralysis of the limbs, disruption of cranial innervation, sensitivity disorders, pelvic organ functions, etc.;
electrotraumatic encephalomyelosis, which is characterized by monosymptoms - hemiplegia, damage to the optic nerves, etc.;
often after electrical trauma, epileptiform seizures develop, occurring as general or local seizures;
damage to peripheral nerves - mononeuropathy (ulnar, peroneal and often caused by local thermal effects of current);
it is possible to develop a syndrome of complete disruption of spinal cord conduction;
functional disorders of the autonomic nervous system: lability of facial vasomotors, flushing of the face, acrocyanosis, hyperhidrosis, local edema, palpitations, dizziness, headache - these phenomena are usually accompanied by complaints of increased irritability, emotional excitability, fatigue, etc.;
Damage to cranial nerves due to electrical trauma is usually associated with subarachnoid hemorrhages.

Functional disorders of the central nervous systems in persons who have suffered electrical trauma remain for a long time, which leads to complete or partial loss of performance. Victims experience decreased memory and attention, absent-mindedness, and increased fatigue (asthenia).

In addition to the above (regarding damage to the autonomic nervous system), it should be noted that autonomic disorders with electrical trauma, they manifest themselves in pupillary abnormalities, loss of peripheral pulse, coldness, pallor or cyanosis of paralyzed limbs. Prolonged respiratory paralysis and binocular mydriasis can simulate death. This explains why people who “died” from electrical trauma “revive” after a long period of time, after cardiopulmonary resuscitation. A similar syndrome is observed when injured by high voltage industrial current.

Mononeuropathies. Damage occurs both due to coagulative necrosis of the nerve itself and the muscles, resulting in their swelling, leading to compression of the nerves. In the delayed period, the nerve may also be compressed by scar tissue. Low voltage current can damage peripheral nerves only with prolonged contact or when skin resistance decreases. In these cases, the nerve is sometimes affected at a distance from the point of entry of the current, for example, the passage of current from hand to hand can cause brachial plexopathy. But usually one nerve is affected, which is manifested by pain at the time of the electric shock and muscle weakness in the area of ​​​​the corresponding innervation, developing approximately one (1) hour after the injury. As a rule, recovery is complete.

The typical result of lightning passing through the body is transient peripheral sensorimotor paralysis. Charcot called it “keraunoplegia” - "lightning paralysis"(Greek ceraunos – lightning).

The passage of high voltage electrical current through the spinal cord causes the development of delayed myelopathy with damage to the white matter. Pyramidal defects predominate, sensory disorders are less pronounced; pelvic disorders are not typical. Symptoms develop approximately a week after the electrical injury. A third of patients recover completely, in a third some symptoms remain, and in a third of cases the symptoms remain stable. This condition should be differentiated from compression of the spinal cord during a fracture of the thoracic vertebrae, which can be observed as a result of a fall during injury or tetanic contraction of the paravertebral muscles during an electric shock. The diagnostic sign is the absence of pain.

When exposed to low voltage current, it may occur spinal atrophic palsy caused by damage to the gray matter. Its development is also delayed - after weeks or months, a loss of muscle tissue innervated from the segments through which the current passed appears. After a few months, the process stabilizes, and sometimes improvement is possible.

Brain damage. The skull has a high resistance, protecting the brain from the effects of electricity. Only high voltage current passes through it. The heat generated by this passage causes coagulation of blood in the underlying dural sinuses and coagulative necrosis of the brain. Exposure to electric current also causes cerebrovascular complications, such as cerebral infarction, subarachnoid and intracerebral hemorrhages. The exact reason for their development is unknown. Probably high temperature causes coagulative necrosis of the endothelium and muscular lining of the brain vessels, the arteries become dilated, and fusiform aneurysms are formed. In addition, thrombosis, cardioembolism from a parietal thrombus, and vessel rupture may develop. Venous sinus thrombosis can also cause cerebral infarction. Other causes of cerebrovascular complications may be acute intracranial hypertension (up to 400 mmH2O) and cardiac arrest.

Clinical observations have shown that electric current promotes exacerbation of a chronic pathological process or development of a new disease. Electric current, more than other traumatic factors, has the ability to cause disturbances in all systems of the body at the time of its impact. Therefore, in the first hours and even the next few days after an electrical injury, it is difficult to determine the further course and outcome of the disease.

Often severe electrical injury ends in death, the mechanism of which comes down to three points: inhibition of the functions of the medulla oblongata; ventricular fibrillation of the heart, caused by the direct passage of electrical current through the heart; tetanic spasm of the respiratory muscles.

In the long term after electrical trauma, it sometimes develops psychoorganic syndrome due to progressive atrophy of the brain substance and hydrocephalus. Characterized by persistent headaches, asthenia, memory impairment, emotional and autonomic lability. Peripheral autonomic syndromes (local cyanosis, hyperhidrosis or anhidrosis, local graying or hair loss, etc.) are also common. After electrical trauma, prolonged asthenic states are possible, in which psychopathy is often observed. Differentiation of these syndromes, sometimes similar in appearance, requires a detailed clinical examination.

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Electrical trauma is a combination of various pathological processes in the body exposed to electric current. The most common cause is neglect of safety rules when working with electrical appliances or wiring, but injury from atmospheric electricity (lightning strike) is also possible.

Causes of electrical injury

Trauma in the global sense is damage caused by exposure to extreme mechanical, chemical, physical influences, whose strength exceeds the body’s ability to resist them. Obviously, in the case of electrical injury, such an impact is the passage of a relatively high intensity electric current through the human body.

Typically a person is affected by:

• use of faulty household or industrial appliances;
• non-compliance with safety standards by workers in the relevant field (electricians, equipment installers, electrical machine operators, etc.);
• lightning strike if safety precautions are not followed during a thunderstorm.

Most often, people receive an electric shock at home, and in recent years the frequency of such cases has been steadily increasing due to the widespread distribution of electrical appliances and equipment and not always a responsible attitude to their serviceability.

Children get electrocuted due to their curiosity and lack of ability to predict the consequences of their own actions. An unattended child may well try to open the TV, cut off a piece of a “very necessary” wire, or simply plug some object into the socket.

Symptoms of electrical injury

Conventionally, doctors divide the symptoms of this type of injury into local and general. The current-carrying part of an electrical device, when in contact with body tissues, damages them through two mechanisms:

• contact electric burn occurs when an electric current flowing through tissues heats them to ultra-high temperatures;
• thermal burns occur less frequently and only when a hot voltaic arc appears.

Doctors divide local burns according to the stages of their progression:

1. In the first stage, the skin turns red. Imprints of a conductive object - an electrical tag - are formed on it.
2. The second stage is characterized by the formation of bubbles. Unlike a regular thermal burn, there is no liquid in electrical trauma.
3. In the third stage, the skin is affected to its full depth, there is dry necrosis (death), but the subcutaneous structures are intact.
4. The final stage is manifested by damage to deep tissues, starting from the subcutaneous fat layer and ending with the bones (charring).

Important: Electrical burns have a number of features. Thus, due to the contact mechanism of the traumatic agent, the shape of the burn follows the shape of the object that served as the source of current. The skin in the affected area can be metalized with particles of metal that make up the conductor. The site of an electric burn is rarely painful, since pain receptors stop functioning under the influence of electric current.

Despite the external brightness and “scaryness” of electrical burns, they are not always as dangerous as the general effects of electricity on the body.

When receiving an electric shock, absolutely all organs can be damaged, and primarily the nervous system, since nerve fibers, by their nature, are the best conductors of electricity.

The first sign of damage is muscle contraction. When exposed to high voltage current, a powerful contraction of all muscles occurs, which most often throws the victim away from the source of electricity. With a low-voltage current, a persistent spasm of all muscles occurs and this can be even more dangerous, since the effect of electricity is very long.

At the moment of contact, the person feels a burning pain and trembling that permeates the entire affected limb. Four out of five victims lose consciousness at the time of injury and fall. This sometimes helps to break away from the electrical device and stop the current from affecting the body. However, loss of consciousness often leads to additional injuries if work is carried out at heights or in dangerous conditions - a person can break, fall on sharp objects, or die if a fire breaks out. Most often, consciousness returns relatively quickly even without additional measures to bring the injured person to his senses. If the victim does not come to his senses for a long time, then brain damage is very likely.

Those who have suffered an electrical injury experience the following symptoms:

• acrocyanosis (blueness of the lips), combined with pale skin;
• lethargy, drowsiness, apathy;
• decreased blood pressure;
• amnesia;
• dysfunction of the spinal cord, manifested in the form of impaired coordination of movements, changes in reflexes, disorders of the pelvic organs (urinary and fecal incontinence).

The most life-threatening symptom is cardiac arrhythmias. Heart rhythm disturbances often occur only a few hours after the injury, after a period of apparent well-being. That is why every person exposed to an electric shock should be hospitalized, since in a hospital setting he has a greater chance that the arrhythmia will not go unnoticed.

However, when exposed to high-voltage electric current, the rhythm may become disrupted already at the time of injury. This most often becomes the cause of death of victims.

There is also a high probability of breathing problems, even stopping. But even without a stop, there is a risk of developing respiratory distress syndrome - a situation where oxygen cannot pass from the lungs to the blood.

A sign of a disturbance in the functioning of the nervous system are convulsions, which appear in most cases. Convulsions can be so strong that they sometimes even lead to fractures.

When a voltaic arc appears at the time of injury, damage to the organ of vision is possible. Cataracts (clouding of the lens) occur in 6% of cases of electrical trauma due to exposure to high voltage current. Retinal detachment and intraocular hemorrhages are very unpleasant diseases, sometimes leading to complete irreversible blindness.

First aid for electrical injury

Emergency measures for electrical injury consist of several steps:

• stopping exposure to electric current;
• provision of first aid;
• provision of qualified care in a hospital setting.

First of all, it is necessary to stop the exposure of the victim to electricity by:

• de-energizing the current source (turn off the switch, unplug the plug from the socket, cut the wire with an ax with a wooden handle;
• throwing the victim away with any wooden, plastic or rubber object (do not hit, but push or pull away!);
• dragging the victim to a safe place.

Note: the victim himself is a conductor of electric current. When releasing it from the current, do not forget to protect yourself! You need to wear rubber galoshes, gloves, or wrap your hands in a dry cloth. It is advisable to place a dry board or rubber mat under your feet. The victim should be pulled away from the wire without touching the exposed parts of his body, i.e. at the ends of the clothes. Try to operate with one hand.

Important: It should be remembered that if the current source is a high-voltage wire lying on the ground, then you should approach the victim in steps, one foot long and without lifting your feet from the ground. This is due to the fact that with a large distance from one leg to the other, a potential difference arises between them, and the rescuer can also receive an electric shock.

Once the victim is safe, check for a pulse in the carotid artery and spontaneous breathing. If they are absent, cardiopulmonary resuscitation is started immediately.

Even before hospitalization, depending on the severity of the injury, the following may be used:

• analgesics - from paracetamol to morphine;
• drugs that increase blood pressure - solutions for intravenous infusion, dopamine;
• anticonvulsants - diazepam;
• blood thinning drugs - heparin, enoxaparin, etc.;
• antiarrhythmic drugs - lidocaine, verapamil, beta blockers, amiodarone, etc.

All electrical burns must be covered with dry bandages before transportation.

In the intensive care unit, the administration of solutions to combat possible shock continues, diuretics are used for lesions in the head area, heart medications, blood thinners and other medications are used.

In some cases, surgical treatment of an electrical burn may be necessary, ranging from removal of dead tissue to amputation of a non-viable limb. Fractures are treated according to the general rules - plaster immobilization, traction, osteosynthesis using knitting needles, plates, etc.

Electrical trauma is a set of traumatic disorders that appear in the human body as a result of exposure to industrial, household or natural electric current. Electrical injury can have serious complications. In some cases it leads to death.

The main causes of electrical injuries in children and adults

Both children and adults can suffer electrical injury either as a result of exposure to electric current at home or at work, or from a lightning strike. Lightning damage should be considered as a natural, force majeure factor, from which a person cannot always protect himself. In other cases, electric shock injury occurs for the following main reasons:

1. Psychophysiological.
2. Technical.
3. Organizational.

Reasons related to the human psyche and physiology include decreased attention, a stressful situation, excessive fatigue, the state of health of an adult or child, a person being under the influence of drugs or alcohol, and various other reasons.

Technical reasons mean:

Organizational causes of electrical injuries include:

• Negligence when handling live electrical installations when they are left without proper supervision.
• Neglect of basic safety rules both in everyday life and in the workplace.
• Carrying out work on electrical equipment without first checking that there is no voltage on it.

People who deal with electricity professionally are the most likely to suffer electrical injuries!

These include electricians, assemblers of high-voltage structures, builders, and other specialist workers.

Electrical injuries usually occur when:

• Presence of dangerous electrical voltage and current.
• Features of the body and the specific health status of the victim.
• Environmental conditions.

Severity of electrical injuries

Depending on the nature of the injury, injuries may include:

• Are common , in which the current passes through the entire human body, so various muscle groups suffer, convulsions, paralysis of the heart and breathing occur.
• Local when, as a result of a short circuit, the integrity of the skin and tissues is damaged. The victim receives an electric shock.

According to the severity of injuries resulting from the action of electric current, they are divided into 4 degrees:

• For first degree trauma The victim is conscious and exhibits the following symptoms:

When the impact of the traumatic factor stops, a person often begins to experience pain!

• Second degree characterized by loss of consciousness of the victim and severe tonic convulsions. In this case, the patient’s blood pressure is low, and slight respiratory distress is observed. Often at this stage, cardiac arrhythmia already appears and shock occurs. The consequence of trauma can be memory loss.

• At the third stage The patient's condition can be described as severe with the following symptoms:

1. Severe respiratory distress and convulsions. Laryngospasm may occur.
2. Ruptures of blood vessels in the lungs.
3. Disruption of the heart and, as a consequence, the entire blood circulation. Blood pressure drops significantly, the rhythm of cardiac activity is disturbed.
4. Damage to internal parenchymal organs up to the appearance of necrotic foci in the liver, kidneys, lungs, spleen, as well as in the thyroid and pancreas.
5. Retinal detachment.
6. Edema of the brain and lungs.

At this stage, the patient may fall into a coma!

• Fourth degree – this is a complete cessation of breathing as a result of paralysis of the respiratory center and fibrillation of the ventricles of the heart, leading to the clinical death of the patient.

Respiratory paralysis is most common for injuries in which an electric current passes through a person's head!

There is also a division of electrical injuries, depending on the nature of the impact of the current, into:

• Instant when a person receives a very strong electrical discharge in a few seconds, exceeding the permissible level.
• Chronic . Such injury is typical for people who are in constant and prolonged contact with sources of strong current. In a state of chronic electrical trauma, a person experiences memory and sleep disturbances, he often has a headache, he gets tired quickly, and experiences a feeling of persistent fatigue.

How is the disease diagnosed?

The characteristic signs that appear in him will help you understand that a person has suffered from an electric shock.

In case of a mild electrical injury, the victim experiences:

• Dizziness.
• Fainting.
• Impaired vision, smell and hearing.
• Frustration, lack of strength, or, conversely, an excited state.
• Neurotic reactions.

Severe electrical injury can be recognized by the following signs:

When injured by a lightning strike, the following symptoms are observed:

• Blindness.
• Temporary muteness and deafness.
• Feeling of fear.
• Headache.
• Photophobia.
• Cardiac and respiratory paralysis.
• "Imaginary" death.

The more serious the injury, the more pronounced the specific symptoms appear.

In some cases, electric shocks lead to instant death of the patient!

Providing emergency first aid for electrical injuries

• In order to competently help a person exposed to electric current, you must first take personal safety measures. They consist of wearing thick rubber shoes and gloves, since there may be a high voltage wire nearby that has fallen to the ground.

You should not come closer than ten meters to a live wire!

If there is no rubber uniform nearby, you can protect yourself in this way: start moving towards the victim in the so-called “duck step”. The steps should be very small, they should be taken in such a way that the feet do not leave the ground, and during each next step the toe of one foot and the heel of the other are in the same line.

• Next, you should stop contacting the victim with the current source.

It should be remembered that water is an excellent conductor of electricity, and dry wood is an excellent insulating material!

To stop the electric discharge, you need to unplug the electrical cord from the outlet or turn off the switch. If this is not possible, you should throw the wire to the side with a long wooden or any non-metallic stick. You can cut or cut the electrical wire with an insulated tool.

If a person who is under voltage is at a high altitude, before turning off the current, measures should be taken to ensure that the victim does not break if he falls!

• Then you need to pull the person who received the electrical injury away from the current zone by about 10-15 meters, holding him by the edges of his clothing.

Do not touch the exposed parts of the victim’s body!

• After this, you need to check whether the person is conscious and has breathing and a heartbeat. If they are absent, you must immediately begin giving the person indirect cardiac massage and artificial respiration.

You can start cardiopulmonary resuscitation only after making sure that the effect of the current on the human body has stopped!

If the victim did not lose consciousness, you need to give him any sedative, for example, Corvalol in the amount of 50-100 drops.

• Cold should be applied to the patient's head. In the cold season, it is enough to simply remove your hat.

• If there are wounds or burns on the body, they need to be bandaged with a clean, preferably sterile, cloth. If fractures are suspected, secure the limbs with splints.

First aid to the victim in the video:

Measures to maintain vital functions during burns

After providing the necessary assistance to a person who has received an electrical injury of the 2nd, 3rd or 4th degree of severity, he should be immediately taken to the traumatology or surgical department of the hospital. There the patient will receive qualified medical care. In case of electrical injury of the 1st degree of severity, hospitalization is not always necessary.

Every person who has received an electrical injury must be vaccinated against tetanus!

Therapeutic inpatient care for a victim of electrical injury includes:

• Local treatment of burned areas of the body.
• General treatment aimed at maintaining and restoring all disturbed systems and functions of the body.

As a local anti-burn measure, sterile bandages soaked in disinfectant solutions are applied to the entry and exit points of electrical discharges.

Subsequently, burns on the skin are exposed to ultraviolet irradiation to facilitate the process of death of tissues susceptible to necrosis and to accelerate the restoration of healthy epithelium. Patients are also prescribed baths with a solution of potassium permanganate, and medicinal regenerating bandages are applied to the burned areas.

If the resulting skin defect requires correction, the patient undergoes plastic surgery!

In parallel with local treatment of burns, intensive infusion therapy is carried out to normalize cardiac activity and restore both central and peripheral hemodynamics. Doctors also prescribe anti-shock and oxygen therapy, sedatives and antihypertensive drugs to patients.

Basically, all drugs are introduced into the patient’s body through intravenous or intramuscular injections, as well as through droppers!

On the first day, the amount of drugs administered intravenously, taking into account the severity of the shock, is from 30 to 80 milliliters per kilogram of the patient’s body weight. In this case, urination is monitored hourly. Normally, the victim should produce about 1.5 -2.0 ml/kg of urine.

On the second and third days, the volume of drugs infused by infusion is reduced by approximately 30 percent. Among other drugs, the victim must be given heparin, vitamins, painkillers and heart medications, drugs to reduce arrhythmia, antispasmodics and adrenergic blockers. The most commonly used electric shocks are:

If the patient has wounds in the skull and has experienced prolonged loss of consciousness, he requires enhanced dehydration therapy!

In the presence of lesions of the extremities, nicotinic acid and papaverine with novocaine solution are used.

Amputation of limbs is done as a last resort - in case of irreversible tissue necrosis!

Electrical trauma with deep lesions of the muscle fascia often requires surgical intervention in the form of necrotomy, dissection and drainage of tissue.