Electrocution injuries can result in a variety of wounds, and sometimes in death. Factors that determine the extent and severity of electrocution injuries include the type of current, the duration of contact with the current, the pathway of electricity through the body, the type of circuit and amount of voltage encountered. It is important to understand the mechanism of injury, as electrocution injuries may be caused by direct contact with an electrical source, arcing of electricity, flash (caused by heat from close contact with an electrical arc) and flame (combustion of clothes from arcing and electrothermal currents). Damage to any organ system may result from electrocution injuries.
Asystole (absence of a cardiac rhythm, “flat line”) or ventricular fibrillation (chaotic and useless fluttering of the ventricles) can occur as a consequence of electrocution injuries. Both are lethal rhythms and result in death if not treated immediately. Low-voltage AC is more commonly the cause of ventricular fibrillation, while asystole may be caused by high-voltage AC or DC. There is good chance of resuscitation from either of these rhythms with immediate treatment. Victims may also experience abnormal cardiac rhythms and direct damage to cardiac muscle, although long-term damage is not common.
Due to their poor ability to conduct electricity, the lungs are less often damaged by electrocution; exceptions to this occur when the current passes through the chest and causes tetany of the chest muscles, resulting in respiratory arrest, and when electricity passes through the area of the brain that controls breathing. When either of these two scenarios occurs, the victim may suffer a respiratory arrest requiring resuscitation.
Central nervous system
Most head and spinal cord injuries occur as a result of blunt trauma. Victims of electrocution often fall from heights or are thrown from the electrical source. Anyone suffering an electrocution injury should be assumed to have a spinal cord injury until proven otherwise. The spinal cord itself may be damaged if the current passes from hand to hand (through the body). Following an electrocution injury, victims may lose consciousness, be confused or have amnesia regarding the event. Long-term complications can include:
- Psychiatric problems (depression, aggression)
- Delayed spinal cord problems
- Damage to the peripheral nerves
Massive damage to muscles as a result of prolonged tetany may cause rhabdomyolysis and kidney damage. Victims may suffer fractures from falling or being thrown. Severe burns may cause compartment syndrome, necessitating a fasciotomy. Trauma due to falling or being thrown may result in a variety of injuries to various organs. Victims who fall or are thrown large distances should be seen by a trauma team as soon as is feasible.
The skin and soft tissues are often the most severely affected by electrocution injuries. Burns to the skin may be severe. Burns may appear the worst at contact and ground points. It is important to determine the extent of burn injuries and also the extent of damage to the tissue below the skin. Severe burns should be treated at burn centers, where the staff is familiar with these types of burns and their presentation, as well as their potential complications.
The tympanic membranes (eardrums) are often ruptured. In addition, approximately 6% of victims of electrocution injuries develop cataracts. Cataracts may not appear until months after the initial event, and occur with greater frequency when the contact with electricity is close to the head.
A variety of injuries to multiple organ systems may result when an individual suffers an electrocution injury. The mechanism of electrocution injuries may provide important clues as to suspected damage to organ systems. Traumatic injury may occur as a result of electrocution injuries, and a high index of suspicion should be present with these types of injuries.