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A 10-Year-Old With Electrical Burn

Author: Alejandro Balzaretti, MDSeries Editors: Sheryl Falkos, MD, and Rosa A. Vidal, MD

February 13, 2006

Introduction

A 10-year-old white boy presented to the emergency center with multiple burns. He had been playing with a
battery charger that his father had taken apart to fix. He plugged the charger to an outlet (110 volts [V]) while
holding the circuit board on the other hand and received an electric shock. As a result, he got 3 burns; a small
one on the fingertips of the right second and third fingers, another on the dorsum of the left hand, and a third on
the chest. After the shock occurred, the patient fell to the ground and did not experience further trauma.
However, he did lose control of his bladder. The father reported no loss of consciousness, seizures, muscle
spasms, or bleeding following the shock.

The past medical history was unremarkable.

Physical Examination

The patient was alert, cooperative, and in no acute distress

Vital Signs:

Oral temperature 99.4º F (37º C) , pulse 108, respiratory rate 25/min, blood pressure 132/53 mm Hg
Weight: 37.3 kg

Peripheral oxygen saturation/room air: 97%

HEENT: Pupils were equal, round, and reactive to light and accommodation. Tympanic membranes were clear.
Oral mucosa was pink and moist.

Neck: Supple

Chest: Lungs clear to auscultation; 1-cm brown lesion with peripheral erythema at the left parasternal border at
the 5th intercostal level

Cardiovascular: Irregularly irregular rhythm, with no murmurs, rubs, or gallops

Abdomen: Soft, nontender, nondistended, with bowel sounds present; no hepatosplenomegaly

Extremities: Moving all extremities well, pulses positive bilaterally, no edema; pinpoint burns on the 2nd and
3rd fingertips of the right hand, and 3 cm2 burn on the dorsum of the left hand.

Neurologic: No focal deficits

Laboratory Analyses

Chemistry Panel: Sodium 141 mEq/L, potassium 3.6 mEq/L, Chloride 104 mEq/L, BUN 17 g/dL, creatinine 0.7
mg/dL, glucose 105 mg/dL, calcium 9.1 mg/dL, total protein 8.1, albumin 4.5, pre-albumin 27.6, total bilirubin
0.2, alkaline phosphatase 364, AST 21, ALT 47

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Cardiac Enzymes: Cardiac troponin I < 0.04, CPK 119, serum cardiac creatine kinase isoenzyme (MCKMB)
1.2, myoglobin 50

ECG on admission.

The ECG shown in Figure 1 was interpreted as normal sinus rhythm with occasional premature atrial
complexes (PACs); probable left ventricular hypertrophy

Echocardiogram: Trace of tricuspid regurgitation and pulmonary insufficiency

Discussion

The patient was admitted and treatment with intravenous fluids (IVF) at 100% maintenance rate, and
cardiopulmonary monitoring was initiated. He was restricted to bed rest with elevation of the affected
extremities. Pain management was acetaminophen with codeine as needed for pain and morphine for
breakthrough pain. Daily dressing changes were made with collagenase ointment and polysporin powder, and
dressings contained sulfamylon solution. Collagenase was not applied to the chest wound so as not to expand
the depth of the wound, as it was in close proximity to the pleural space.

Consultations with the Surgery and Cardiology departments were obtained.

Surgery Consult: Surgery recommended cardiac monitoring and IV fluids to maintain euvolemia;
neurovascular checks every hour of bilateral upper extremities because of risk of damage to neurovascular
bundles in the pathway of the electrical shock; and elevation of the upper extremities to decrease edema.

Wounds were dressed in Thermazene, with dressing changes each day. Surgery consulted Plastic Surgery for
possibility of grafting of finger wound, but this was ultimately not required.

Cardiology Consult: Cardiac enzymes were assessed as normal. No structural abnormalities were seen on
echocardiogram. Trace tricuspid regurgitation suggested mildly elevated right ventricular pressures, but
pulmonary artery diastolic pressures were normal. No right ventricular hypertrophy or chamber enlargement
was noted; there was shortening fraction of 44%. Cardiology recommended repeat ECGs.

The patient's cardiac condition was assessed with subsequent ECGs (Figures 2 and 3).

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ECG on Day 1 following admission.

Interpretation of ECG in Figure 2: Normal sinus rhythm with isolated premature atrial contractions; borderline
left ventricular hypertrophy

ECG Day 3 following admission.

Interpretation of ECG in Figure 3: Normal sinus rhythm with premature atrial contractions and atrial bigeminy;
left ventricular hypertrophy

The patient continued to have PACs throughout his stay, but with much less frequency.

The patient was discharged on Day 6. He was to continue wound dressing care daily, follow up with Surgery in
1 week, and complete a 10-day course of clindamycin for his wound infection. He was to follow up with his
primary pediatrician in 2 weeks; a follow-up with cardiology was not needed.

How often do electrical burns happen in the United States?

A.

View the correct answer.

Which is more dangerous: direct current (DC) or alternating current (AC)?

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A.

View the correct answer.

What types of cardiac arrhythmias can be expected from an electrical injury?

A.

View the correct answer.

What are the most significant clinical complications to consider when treating a patient who has suffered an
electrical injury?

A.

View the correct answer.

References

1. Hostetler MA. Burns, electrical. eMedicine. 2004. Available at:

http://www.emedicine.com/ped/topic2734.htm. Accessed February 7, 2006.

2. Up To Date. Environmental electrical injuries, organ involvement cardiac injuries. 2005. Available online
by subscription only at: http://www.utdol.com/application/topic.asp?
file=cc_medi/26404&type=A&selectedTitle=1~1.

3. Disorders due to physical agents; electric injury. The Merck Manual of Diagnosis and Therapy. Available
at: http://www.merck.com/mrkshared/mmanual/section20/chapter277/277a.jsp. Accessed February 7,
2006.

4. Antoon AY, Donovan MK. Burn injuries. In: Behrman RE, ed: Nelson Textbook of Pediatrics, 17th
edition. New York, NY: Elsevier; 2004: 337t.

Medscape Pediatrics. 2006;8(1) © 2006 Medscape

Cite this: A 10-Year-Old With Electrical Burn - Medscape - Feb 13, 2006.

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