Electrical burns, caused by an electrical current passing through the body, present a unique danger compared to typical thermal burns. When electricity travels through human tissue, it generates heat, causing damage far beyond the skin’s surface. The primary threat is not the visible scorched skin but the potential for widespread destruction of internal structures like nerves, muscles, and blood vessels. This deceptive nature requires a special principle to guide both initial assessment and subsequent medical treatment.
The Critical Principle: Internal Damage Outweighs Surface Injury
The most important principle in managing an electrical burn is that the visible external injury does not accurately reflect the severity of the internal damage. The appearance of the skin, which may only show small entry and exit wounds, can be misleadingly benign while catastrophic destruction occurs deep inside the body. This is because the body becomes a conductor, allowing the electrical current to travel along the path of least resistance.
Tissues with low resistance, such as nerves, blood vessels, and muscle, conduct electricity easily and are destroyed as the current heats them up, a process known as Joule heating. Conversely, high-resistance tissues like bone and skin resist the flow, causing the heat to dissipate more intensely at the point of contact, which creates the visible burn marks. The amount of current (amperage), rather than the voltage, is the main determinant of injury severity.
The path the current takes through the body is a major factor in determining which organs are affected. For example, a current passing from hand to hand or hand to foot may traverse the chest, putting the heart at direct risk. This principle demands a high index of suspicion for systemic injury, even when the skin appears minimally affected.
Systemic Threats: Cardiac and Renal Damage
The hidden internal tissue destruction from an electrical injury poses two systemic threats: damage to the heart and failure of the kidneys.
When the current passes through the chest, it can disrupt the heart’s natural electrical rhythm, potentially leading to cardiac arrest. Alternating current (AC), the type found in most household outlets, is particularly dangerous because it can induce ventricular fibrillation. This disruption can occur even with low-voltage exposure, and heart rhythm abnormalities may be delayed for several hours after the incident.
Damage to the internal skeletal muscle tissue is widespread, a condition called rhabdomyolysis. This process releases large amounts of cellular contents, including the protein myoglobin, into the bloodstream. Myoglobin is toxic to the kidneys, and the large quantities released quickly overwhelm the organs’ filtering capacity. This can lead to acute kidney injury (AKI) or complete renal failure, a serious complication of electrical burns. Fluid replacement is necessary to flush the myoglobin out of the body and prevent this outcome. High levels of creatine kinase (CK), an enzyme released from damaged muscle, are used to monitor the severity of rhabdomyolysis and the risk of kidney complications.
Immediate Action and Seeking Specialized Care
Given the systemic nature of electrical injuries, immediate action must prioritize safety and rapid professional medical intervention. Before approaching the injured person, ensure the scene is safe by disconnecting the power source, if possible. Once secured, an initial assessment involves checking for breathing and a pulse, and beginning cardiopulmonary resuscitation (CPR) if necessary.
Due to the risk of delayed cardiac arrest and hidden internal damage, any person who has sustained an electrical injury requires immediate emergency medical evaluation. Even a seemingly minor shock with no visible burn marks warrants a trip to the hospital. The full extent of the damage cannot be determined by a quick inspection alone.
Specialized burn centers are often required for definitive care, as they have the expertise and resources to monitor for complications like cardiac arrhythmias and acute kidney failure. Doctors will use various tests, including electrocardiograms (ECGs) to check heart function and blood tests to monitor muscle enzyme levels, to assess the true internal damage. Seeking this specialized care is the only way to manage the invisible, life-threatening consequences of an electrical current passing through the body.