Case Report

“Electrical Injury”

Wahidah Hardyanti Sukaji

H1A014079
Pembimbing:
dr. Arfi Syamsun, Sp.KF, M.Si.Med
Introduction
 Background

• Electric injury is a type of trauma caused by contact with objects that have an
electric current, which can cause burns as a result of the change in electrical energy
to heat energy.
• In the United States around 1000 people died because of electrical shock.
• The electrical end of shock in a person is very dependent on the intensity or voltage
of exposure to a person, the direction of flow entering the body, the state of the
body, immediate and adequate therapy.
• Treatment that can immediately reduce or even eliminate the losses caused.
Case Report
 PATIENT IDENTITY

• Name : Mr. BM
• Gender : Male
• Age : 17 years
• Religion: Moeslem
• Status : Unmarried
• Address: selong, East Lombok
• MR :610182
 Anamnesis
• Patients came to the West Nusa Tenggara Provincial Hospital referral from Selong
Hospital. Patients present with complaints of decreased consciousness due to
electrocution when going up to level 2 of the house. It is not known exactly why
the patient rises above the level of his unfinished house. The patient is
electrocuted from the electrical cable in the house. It is not known for sure how
long the patient was electrocuted, the patient was known to be electrocuted by his
aunt after hearing the sound of objects falling from above the level of the patient's
house. Patients are found using only clothing and footwear, without gloves or
other protective equipment.
• When the patient is stung supine and the patient is unconscious. Burns on the
head, face, right leg, and around the right ankle are found. The patient was
diagnosed with Electrical burn grade II. According to the rules of nines, patients
experience burns of approximately 18%.
 EXAMINATION RESULT

GCS: E1V1M4
BP: 105/70
RR: 27
PR: 110
T: 36,8
Wound description
• Region: head
• Coordinate: four centimeters from the right
eyebrow, four centimeters from the right ear. The
left side border is parallel to the midline of the
nose. The lower limit of the wound is parallel to
the corner of the right lip.
• Type: burn wound
• Characteristic:bentuk luka tidak beraturan, tepi
luka beraturan dan berbatas tegas, sudut luka
tumpul, luka dasar berwarna putih dan terdapat
sisi luka yang berwarna kehitaman, teraba kasar,
tidak ada tebing luka, tidak ada jembatan
jaringan, tidak terlihat tulang yang menonjol.

• Size: 10 x 15 cm
Wound description
• Region: head
• Coordinate: luka berada pada bagian kepala
yang di tumbuhi rambut
• Type: burn wound
• Characteristic:bentuk luka tidak beraturan,
tepi luka beraturan dan berbatas tegas, sudut
luka tumpul, luka dasar berwarna putih dan
terdapat luka yang berwarna kehitaman,
teraba kasar, tidak ada tebing luka, tidak ada
jembatan jaringan, tidak terlihat tulang yang
menonjol.
• Size: 8 x 7 cm
Wound description
• Region: leg
• Coordinate: the upper limit of the wound is
four centimeters from the knee, and the lower
border is about one centimeter from the right
ankle.
• Type: burn wound
• Characteristic: irregular shape of the wound,
irregular edges of wounds and well-
demarcated, blunt angle of wound, white
wound base and blackish side wound, rough
palpable, no cliff wound, no network bridge,
no visible protruding bone.
• Size: 30x 5cm
Wound description
• Region: leg
• Coordinate: the upper border of the wound is
nine centimeters from the front left ankle, and
the lower limit at the third and fourth
fingertips.
• Type: burn wound
• Characteristic: irregular shape of the wound,
irregular edges of wounds and well-
demarcated, blunt angle of wound, white
wound base and blackish side wound, rough
palpable, no cliff wound, no network bridge,
no visible protruding bone.
• Size: 17 x 6 cm
 Planning Diagnostic

• Blood count
• Rontgen Thorax
 Treatment

• O2 with NK 5 lpm
• IVFD RL 30 tpm
• Inj. Ceftriaxone 1 gram/ 12 hour
• Inj Ketorolax 1 ampul/ 8 hour
• Inj Ranitidin 1 ampul/ 12 hour
CASE DISCUSSION
 There are 3 degrees of severity of burns on
electric wounds:
First degree burns
a. Damage is limited to the
superficial epidermal layer
b. Dry skin, hyperemia in the
form of erythema
c. No bulls found
d. Pain due to irritated
sensory nerve endings
e. Cure spontaneously in 5-10
days
Second degree burns
a. Damage covers the epidermis and part of the dermis, in the form of an
inflammatory reaction accompanied by an exudation process
b. Found bull
c. Pain due to irritated sensory nerve endings
d. The base of the wound is red or pale often located higher above normal
skin.
It divided into :
. Degree two A (Superficial) Degree two B (Deep)
a. Damage to the superficial part
a. Damage to almost all parts of the
dermis
of the dermis b. Skin organs such as hair follicles,
b. Skin organs such as hair sweat glands, sebaceous glands are still
follicles, sweat glands and present
sebaceous glands are still intact c. Healing takes longer, depending on
c. Healing spontaneously in 10-14 the remaining epithelial seeds. (usually
more than one month)
days.
 There are 3 degrees of severity of burns on
electric wounds:

Degree III Burns

a. Damage to the entire thickness of the dermis and deeper layers
b. Skin organs such as hair follicles, sweat glands, damaged sebaceous glands
c. No bulls found
d. The burned skin is gray and pale because it is dry lower than the surrounding skin
e. Coagulation of protein occurs in the epidermis and dermis.
Based on the data obtained above, a 17-year-old male suffered burns caused by electric
shock. Burns found on the face, right leg and right ankle area. The patient is allegedly
accidentally touching the patient's head with the electrical cord in the patient's home.

Electric shock is a condition where there is electricity flowing in our body. This happens
because basically the human body is a good conductor and is mostly composed of fluids so
it is able to deliver electricity properly. Electric current can flow well in the body due to the
potential difference between the two connecting points, namely electric current will flow
from a high-voltage point (electronic equipment) to a low-voltage point (ground or
ground).
• When the body's electricity becomes the link between electricity and the ground, this is in
accordance with the nature of electricity that is looking for the closest path to the earth.
• Burns occur because when an electric current enters the body the resistance is caused so
that some of the energy to transfer electrons is converted into heat energy. The pain felt by
the patient is caused by the transfer of electrons which stimulates the nerves excessively.
• Heat energy due to electric current can cause disruption of the function of organs,
especially the heart which can experience cardiac arrest; damage to muscles, nerves and
tissues due to the passage of electricity; and thermal burns due to contact with electric
currents.
when the patient came to the NTB Provincial Hospital emergency room, the
patient's condition was restless with GCS six.
For the degree of burns suffered by patients based on rule of nines, namely, on
examination of burns, the severity of facial injuries was nine percent, and the right
front legs and right legs under the right ankle nine percent, so it entered the
category of level II burn (moderate degree).
Patients have been treated according to the standards of medical services and
wound care at the NTB Provincial Hospital.
CONCLUSION
 Conclussion

• Based on the facts I got from the medical record data of patients with male sex, age
seventeen who had received treatment at the General Hospital of West Nusa Tenggara
Province for 7 days (the twenty-third of November in the year two thousand and eighteen
to thirty November of two thousand and eighteen) I hereby conclude a number of things as
follows
1. Found four burns on the head, face, legs and ankles.
The above is due to electrical trauma this CAN occur due to workplace accidents
2. The wound has been treated according to the standard of service at the Hospital
3. These injuries can cause obstacles in carrying out daily activities
 BIBLIOGRAPHY
Budiyanto A, Widiatmaka W, Sudiono S,dkk. Ilmu Kedokteran Forensik. Jakarta: Bagian Kedokteran Forensik
Fakultas Kedokteran Universitas Indonesia.1997. H: 25 – 54.
Hoediyanto, H. Trauma Listrik. Bagian Ilmu Kedokteran Forensik Universitas Airlangga, Surabaya. [online].
2010. [cited 24 November 2018]. Available from:
http://www.fk.uwks.ac.id/elib/Arsip/Departemen/Forensik/Tr.%20Listrik.pdf
Lecture Notes in Forensic Medicine. Electrical burns.Derrick Pounder, University of Dundee. H: 15.
Wim de Jong. 2005. Bab 3 : Luka, Luka Bakar : Buku Ajar Ilmu Bedah. Edisi 2. EGC. Jakarta. p 66-88
Apuranto .H. dan Hoediyanto., 2007., Buku Ajar Ilmu Kedokteran Forensik & Medikolegal. Edisi Ketiga., Surabaya:
Bagian Ilmu Kedokteran Forensik & Medikolegal Fakultas Kedokteran Universitas Airlangga.
Idries,Abdul M. Pedoman Ilmu Kedokteran Forensik Edisi Pertama. Jakarta: Binarupa Aksara. 1997. H: 108 – 117
Liwang F, Mansjoer A. Sengatan listrik. Dalam: Kapita selekta kedokteran. Jakarta: Media Aesculapius.2014.
p.855-6
Lilard P. Guidance for emergency medical management of electrical injuries. Available at:
www.masscosh.org/sites/default/files/documents/Guidance%20for%20Emergency%20Medical%20Managemen
t%20of%20Electrical%20Injuriesdoc
Thank you