ELECTRIZATION

ELECTRIZATION

I. DEFINITIONS

Electrification : all electrical accidents (EA), it designates all the physiopathological manifestations linked to the action of electric current on the human body.
Electrocution : this is death by the passage of an electric current through the body.
“Arc flash”: thermal burn. No electrification but skin burns from the hot air of the electric arc.

The injuries resulting from the passage of current are polymorphic and depend on the path, the type of current (alternating more dangerous than direct), the voltage (>1000 volts), and the resistance (in a humid environment, sweating).
Among accidents due to electricity (AE), a distinction must be made between those caused by a low voltage current and those induced by a high voltage current.
The severity of low-voltage AEs is essentially linked to the risk of acute cardiovascular accidents.
Circulatory arrests induced by low voltage current are generally due to ventricular fibrillation, which has a rather good prognosis if the rescue chain is effective.
High voltage AEs, with current passing through the body, cause deep Joule burns along the vascular-nervous axes, between the entry and exit points which are the site of damaging lesions.
When electric current passes through a conductor, heat is released which obeys Joule’s physical laws:

Q = I2RT and Ohm: I = V/R.

In these equations, Q represents the heat release produced in joules, I is the current intensity in amperes, R the sum of the resistances in ohms, V the voltage in volts and T the contact time in seconds.
The phenomena of arc and electric flash, responsible for a strong release of heat, cause skin lesions of thermal origin.

Context: obvious (patient in contact with conductive current, patient describing the accident).
Difficult: electrocution with projection or fall.
Most often domestic accidents, but also construction sites or lightning.

III. FUNCTIONAL SIGNS

IV. CLINICAL SIGNS

Assess the depth of a coma using the Glasgow Coma Score (GCS).
Sensory-motor neurological deficit.
Identify the entry point and exit point of the current? general and functional prognosis.
Abdominal palpation, vascular axes and muscle masses.
Detect fractures of limbs or spine.
The energy released by the passage of current can give:
Circulatory arrest: indicates the passage of current into the cardiac area.

-Usually FV.

– Interest in early defibrillation.

Ventilatory arrest: by tetanization of the diaphragm.
Disturbances of consciousness: passage of current through the nervous system or hypoxia.
Electrical burn: the electric current follows the path of least resistance between input and output: in particular vascular, muscular, nervous axes.
Functional impotence may be delayed.
Pregnant woman: risk of MFIU (in utero fetal death) even if electrification is benign.

ELECTRIZATION

V. TREATMENT

Prevent possible fall before cutting the power.
Turn off the power source and move the conductor aside.
Careful mobilization: respect the head-neck-trunk axis.
Severe electrocution (circulatory, ventilatory, neurological severity, electrical burn):

hospitalization in intensive care.
Artificial ventilation after preoxygenation ± anesthesia.
Resuscitation + defibrillation if VF (see course).
Electrical burn: treatment of rhabdomyolysis.
Vascular filling 20ml/Kg 1st hour by crystalloids (SS9%°), must be increased up to 8 to 12 mL • kg-1/% of burned skin surface for the first 24 hours.
Alkalinization: 1mEq/Kg then according to Ph.
Induction of abundant diuresis: filling (4-6l/day) and diuretics.
Benign electrification: simple electrification without any signs:

Peripheral venous route.
Monitoring (SpO2, BP, FR, ECS), O2, analgesics .
hospitalization for a few hours if the systematic ECG shows: ESV, atrial fibrillation.

ELECTRIZATION

Smur intervention criteria.

USIB: burn intensive care unit; USIC: cardiology intensive care unit; DSA: semi-automatic defibrillator.

ELECTRIZATION

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