ELECTRICAL INJURY

Presented by:
Pratiwi Retnaningsih G99161075
Nurul Dwi Utami G99152099

ADVISOR :
DR. AMRU SUNGKAR, SP. B, SP. BP-RE

CLINICAL WORK OF MEDICAL UNIT GROUP OF SURGERY

MEDICAL FACULTY OF UNS-REGIONAL PUBLIC HOSPITAL OF Dr.MOEWARDI
SURAKARTA
2016
DOCTORS, ESPECIALLY DOCTORS ON DUTY IN THE ER. SEVERE
BURNS CAN CAUSE SEVERE MORBIDITY AND DEGREE OF
DISABILITY IS RELATIVELY HIGH COMPARED TO THE INJURY OF
ANOTHER CONDITION. THE ELECTRICITY COMES FROM
ELECTRONS PASSING THROUGH THE CHARGE POTENTIAL
GRADIENT GRADIENT FROM HIGH TO LOW GRADIENT THROUGH A
CONDUCTOR OR CONDUCTORS. ELECTRICITY IS A NECESSITY FOR
PEOPLE BUT RARELY CAUSE PROBLEMS. ELECTRICAL BURNS
OCCUR BECAUSE OF THEIR DIRECT CONTACT WITH THE BODY AS
AN ELECTRICITY CONDUCTOR. GENESIS ELECTRICAL BURNS HAVE
KEJAIAN NUMBERS ARE NOT VERY HIGH COMPARED TO OTHER
TYPES OF BURNS LAIINYA WHICH IS ABOUT 5-7%.
DEFINITION

Burns are injuries due to damage or loss caused tissue in contact with a
heat source such as a fire, hot water, electricity, and chemicals. Injuries
caused by heat from the fire or liquids that can burn a type commonly
encountered from severe burns.
EPIDEMIOLOGY

In the United States, about 1.1 million people per year suffered burns
serious enough and should seek medical care. Approximately 45,000 of
these require hospitalization, and about 4,500 die. Genesis electrical
burns have kejaian numbers are not very high compared to other types
of burns laiinyayaitu around 5-7%.
ETIOLOGY

Burns high temperature (thermal burn)

Chemical burns (chemical burn)
Burns electrical shock (electrical burn)
Radiation burns (radiation injury)
MECHANISM
 PATOPHYSIOLOGY

-Certain properties of electricity and tissue illustrate the

mechanisms of electrical injury and the ability to predict
patients outcomes. These properties include voltage,
current, resistance, and conductance.

- The resistance of a material is its opposition to the

passage of an electric current through it, and its
conductance is its ability to transmit a current. In addition,
electricity can also form arcs and result in the creation of
plasma.
 PATOPHYSIOLOGY

-The three major mechanisms of electricity-induced injury

are as follows:
1. Electrical energy causing direct tissue damage, altering
cell membrane resting potential, and eliciting tetany.
2. Conversion of electrical energy into thermal energy,
causing massive tissue destruction and coagulation
necrosis.
3. Mechanical injury with direct trauma resulting from falls
or violent muscle contraction.
 PATOPHYSIOLOGY:

-
The clinical evidence which suggests that muscle and nerve cell
membranes may be ruptured by electrical trauma is:
The release of large quantities of myoglobin from within the
intracellular space;
The intense spasm and rigor commonly witnessed which suggest that
the muscle cell is
depolarized and perhaps that cytoplasmic ATP levels are inadequate to
dissociate the actinmyosin complex;
The elevated levels of arachidonic acid derivatives of membrane
phospholipids;
The delayed paralysis and nerve cell death years after electrical
trauma in which no thermal
injury component exists;
 PATOPHYSIOLOGY:

-Factors that determine the degree of injury:

1. the magnitude of energy delivered
2. Resistance encountered current
3. current pathway
4. duration of contact
 PATOPHYSIOLOGY: 1. THE MAGNITUDE OF ENERGY DELIVERED

-
-Divide as direct current (DC) and alternating current (AC)
- DC current has the same direction: cause strong muscle
contractions, often throwing the victim from the current
source
-AC alternating current: continuous muscle contraction,
prevent someone from removing her grip with a power
source, arrhythmia voltage> 1000 V can cause damage to
internal organs
 PATOPHYSIOLOGY:

-
 PATOPHYSIOLOGY: DURATION OF CONTACT

Most of the bodys resistance is concentrated in the

skin. The thicker the skin, the greater its resistance. The
skins resistance decreases when broken or when wet.

If skin resistance is high, more of the damage is local,

causing only skin burns. If skin resistance is low, wet or
broken skin, more of the damage affects the internal
organs
 PATOPHYSIOLOGY: ELECTRICAL CURRENT

-
- Are places on the body that is traversed by an
electric current from the entrance to leave the
body Most often enter through the hands and
out through the feet
 CLINICAL SIGNS

-
-Head and neck: head is the main point of
contact for high-voltage injuries, and patients
may show burns and neurological damage.
Patients can undergo cataract

-Cardiovascular system: heart attack, both from

heart rate or ventricular fibrillation, is a common
condition that will occur in the electrical
accident. ECG abnormalities can be found
 CLINICAL SIGNS

-
-Skin: In addition to heart attacks, the most
devastating injuries that occur when electrical
injury is a skin burn, the most severe on the
entry wound and the body is in contact with the
ground.
 CLASSIFICATION OF BURN INJURY
(AMERICAN BURN ASSOCIATIONS)
-
-Based on the depth:
-First degree burns (superficial burns)
-Second degree burns (partial thickness art)
-Third degree burns (full thickness)
-IV degree burns
LUAS LUKA BAKAR
 TREATMENT

-Prehospital:
1freeing patients from exposure sources and
pay attention to the safety of themselves
- Remove all materials that withstand the heat
Room temperature water can be sprayed to
prevent hypothermia and vasoconstriction
 TREATMENT

-Resuscitation Airway:
If there is suspicion of inhalation trauma,
intubate before mucosal edema and obstruction
Can be nebulized RL, NaCl 0.9%, or
bronchodilators Monitor for signs and symptoms
of respiratory distress
 TREATMENT
-Fluid resuscitation:
Liquid options: crystalloid Determination of the
amount of fluids: crystalloid intravascular deficit
3-4x In <the first 4 hours given crystalloid fluids
as much as 3 [25% (70% x BBkg)] ml. 70% is
the total volume of body fluids, while 25% of the
minimal loss of body fluids can cause clinical
symptoms of shock syndrome
 TREATMENT

-Fluid resuscitation: Without the shock or the

case of extensive burns <25-30%, without any
delay or encountered <2hours. The need is
calculated based on the formula Baxter: 3-4 ml /
kg /% broad LB Parkland can also use formula
 TREATMENT
-
Injury cure: 1. after resuscitation airway include:
debridement, nekrotomi, and washing of
wounds For small bullae: conservative, whereas
when the size> 5 cm solved without removing
the epidermal layer thereon Eskar disturbing
perfusion: escharotomy Wash the wound: use
warm water and soap baby shower
 TREATMENT
-Injury cure:
6. The wound moist sterile gauze wrapped with
or without cream moisturizer
7. Wound treatment with occlusive dressing to
prevent excessive evaporation
8. Tulle used as wound coverings that facilitate
drainage and epithelialization
9. Antibiotics to overcome the infection in the
wound
 USE OF PROPHYLAXIS ANTIBIOTIC
- In the first 3-5 days the bacteria population
that is often encountered is the Gram-positive
bacteria non-pathogenic. 5-10 Day is a Gram-
negative bacterial pathogens In the first 1-3
days post-injury, the wound is still in a state of
sterile so it is not necessary antibiotics. Some
topical antibiotics that can be used is silver
sulfadiazine, povidone-iodine 10%, gentamicin
sulfate, mupirocin and bacitracin / polymixin
 TATALAKSANA NUTRISI
Calori count by using Harris Benedict formula
Man : 66,5 + 13,7 BB + 5TB 6,8 U

Woman : 65,5 + 9,6 BB + 1,8 TB 4,7 U

Total energy need = KEB x PAx SF

Information:

PA: physical activity (percentage increased every activity: bedrest/

sitdown 20%, mild activity 30%, moderate 40-50%, hard75%)

SF: depend on wide of burn injury

Nutrition count:

Protein : 1,5-2,15 g/kgBB/day

Lemak : 6-8 g/kgBB/day

Karbohidrat: 7-8 g/kgBB/day

 EXICION AND GRAFTING

-Second-degree burns in and three can not

experience spontaneous healing without
autografting. If left unchecked, this dead tissue
will be the focus of inflammation and infection.
Early excision and grafting is currently done by
most surgeons because it has more advantages
over serial debridement.
 COMPLICATIONS
-Complications that can occur in the acute setting is
SIRS, sepsis and MODS. gastrointestinal complications
can occur (mucosal atrophy, mucosal ulceration and
bleeding, decreased bowel motility and ileus.)
-In acute renal tubular necrosis can occur due to
decreased renal perfusion.
-Skin graft loss is a common complication, it is caused
by a hematoma, infection and tearing of the graft.
-At a later phase of burns, scarring can occur in the
form of hypertrophic scarring, keloids, and
contractures.
THANK YOU