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mechanism in a plausible way. Identifying suspicious injuries and
consulting with child abuse specialists can prevent subsequent injuries.

Electrical Burns
Burns that result when electrical current passes through the body have
unique characteristics. Each year, there are more than 4,000 ED visits
caused by electrical injuries, mostly in children. Electrical burns account for
3% of burn center admissions and are increasing in number. Most injuries
occur in young children from contact with low-voltage (less than 120 V)
alternating household current, often from mouthing plugs or extension
cords. Severe high-voltage (more than 500 V) injuries are also seen, often
in adolescent boys as a consequence of risk-taking behaviors.
Thermal energy is released in proportion to the amount and duration of
electrical current that passes through tissue. Current flows preferentially
through tissues of low electrical resistance, such as blood vessels, nerves,
and muscles. Moisture on the skin decreases resistance, accounting for the
greater severity of electrical burn injury in the antecubital, axillary,
popliteal, and inguinal areas. Current arcing through the skin can ignite
clothing and cause severe thermal burns in addition to the electrical injury.
In some direct current electrical burns, a depressed entrance wound and a
blown out exit wound can be identified. If the current traverses the heart,
which occurs more often when the flow is arm to arm, a myocardial injury
may occur. Current through the heart at certain points of the cardiac cycle
can induce ventricular fibrillation or asystole. Electrical injury, especially
by alternating current, can cause tetany of the musculature that may prolong
the contact with the high-voltage source. Tetany of the respiratory muscles
can lead to suffocation.
The initial approach to patients of electrical burns is similar to that in
other children with severe burns. Electrical burns are usually more severe
than they appear. Significant deep and internal injuries may occur in
patients with relatively small external burns. Fluid requirements are higher

than those predicted by formulas based on percentage of BSA because a
larger portion of the injury is internal. Destruction of muscle often causes
myoglobinuria, so serum creatine kinase and urine for myoglobin should be
tested. Renal failure can usually be prevented with forced diuresis and
alkalinization. Electrical injury and edema within fascial compartments can