Spinal shock

Definition

Electric shock injuries are caused by lightning or electric current from a mechanical source passing through the body.

Description

Electric shocks are responsible for about 1,000 deaths in the United States each year, or about 1% of all accidental deaths.

Causes & symptoms

The severity of injury depends on the current's pressure (voltage), the amount of current (amperage), the type of current (direct vs. alternating), the body's resistance to the current, the current's path through the body, and how long the body remains in contact with the current. The interplay of these factors can produce effects ranging from barely noticeable tingling to instant death; every part of the body is vulnerable. Although the severity of injury is determined primarily by the voltage, low voltage can be just as dangerous as high voltage under the right circumstances. People have been killed by shocks of just 50 volts.

How electric shocks affect the skin is determined by the skin's resistance, which in turn is dependent upon the wetness, thickness, and cleanliness of the skin. Thin or wet skin is much less resistant than thick or dry skin. When skin resistance is low, the current may cause little or no skin damage but severely burn internal organs and tissues. Conversely, high skin resistance can produce severe skin burns but prevent the current from entering the body.

The nervous system (the brain, spinal cord, and nerves) is particularly vulnerable to injury. In fact, neurological problems are the most common kind of nonlethal harm suffered by electric shock victims. Some neurological damage is minor and clears up on its own or with medical treatment, but some is severe and permanent. Neurological problems may be apparent immediately after the accident, or gradually develop over a period of up to three years.

Damage to the respiratory and cardiovascular systems is most acute at the moment of injury. Electric shocks can paralyze the respiratory system or disrupt heart action, causing instant death. Also at risk are the smaller veins and arteries, which dissipate heat less easily than the larger blood vessels and can develop blood clots. Damage to the smaller vessels is probably one reason why amputation is often required following high-voltage injuries.

Many other sorts of injuries are possible after an electric shock, including cataracts, kidney failure, and substantial destruction of muscle tissue. The victim may suffer a fall or be hit by debris from exploding equipment. An electric arc may set clothing or nearby flammable substances on fire. Strong shocks are often accompanied by violent muscle spasms that can break and dislocate bones. These spasms can also freeze the victim in place and prevent him or her from breaking away from the source of the current.

Diagnosis

Diagnosis relies on gathering information about the circumstances of the accident, a thorough physical examination, and monitoring of cardiovascular and kidney activity. The victim's neurological condition can fluctuate rapidly and requires close observation. A computed tomography scan (CT scan) or magnetic resonance imaging (MRI) may be necessary to check for brain injury.

Treatment

When an electric shock accident happens at home or in the workplace, the main power should immediately be shut off. If that cannot be done, and current is still flowing through the victim, the alternative is to stand on a dry, nonconducting surface such as a folded newspaper, flattened cardboard carton, or plastic or rubber mat and use a nonconducting object such as a wooden broomstick (never a damp or metallic object) to push the victim away from the source of the current. The victim and the source of the current must not be touched while the current is still flowing, for this can electrocute the rescuer. Emergency medical help should be summoned as quickly as possible. People who are trained to perform cardiopulmonary resuscitation (CPR) should, if appropriate, begin first aid while waiting for emergency medical help to arrive.

Burn victims usually require treatment at a burn center. Fluid replacement therapy is necessary to restore lost fluids and electrolytes. Severely injured tissue is repaired surgically, which can involve skin grafting or amputation. Antibiotics and antibacterial creams are used to prevent infection. Victims may also require treatment for kidney failure. Following surgery, physical therapy to facilitate recovery, and psychological counseling to cope with disfigurement, may be necessary.

Prognosis

Electric shocks cause death in 3-15% of cases. Many survivors require amputation or are disfigured by their burns. Injuries from household appliances and other low-voltage sources are less likely to produce extreme damage.

Prevention

Parents and other adults need to be alert to possible electric dangers in the home. Damaged electric appliances, wiring, cords, and plugs should be repaired or replaced. Electrical repairs should be attempted only by people with the proper training. Hair dryers, radios, and other electric appliances should never be used in the bathroom or anywhere else they might accidentally come in contact with water. Young children need to be kept away from electric appliances and should be taught about the dangers of electricity as soon as they are old enough. Electric outlets require safety covers in homes with young children.

During thunderstorms, people should go indoors immediately, even if no rain is falling, and boaters should return to shore as rapidly as possible. People who cannot reach indoor shelter should move away from metallic objects such as golf clubs and fishing rods and lie down in low-ground areas. Standing or lying under or next to tall or metallic structures is unsafe. An automobile is appropriate cover, as long as the radio is off. Telephones, computers, hair dryers, and other appliances that can act as conduits for lightning should not be used during thunderstorms.

Key Terms

Antibiotics

Substances used against microorganisms that cause infection.

Cataract

Clouding of the lens of the eye or its capsule (surrounding membrane).

Computed tomography scan (CT scan)

A process that uses x rays to create three-dimensional images of structures inside the body.

Electrolytes

Substances that conduct electric current within the body and are essential for sustaining life.

Magnetic resonance imaging (MRI)

The use of electromagnetic energy to create images of structures inside the body.

Skin grafting

A technique in which a piece of healthy skin from the patient's body (or a donor's) is used to cover another part of the patient's body that has lost its skin.

Further Reading

For Your Information

Books

• Dimick, Alan R. "Electrical Injuries." In Harrison's Principles of Internal Medicine, edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1998.

Gale Encyclopedia of Medicine. Gale Research, 1999.