Electrical Burn In Children

WHAT YOU SHOULD KNOW:

• Electrical burns are injuries that may happen when your child touches an electric current (electricity). If a current enters your child's body, it will cause damage wherever it passes. The current causes the most damage to skin and tissue where electricity enters and exits your child's body. Your child's muscles, blood vessels, nerves, bones, and fat may also get damaged. Your child may get electrical burns even if the current does not go through his body. Some causes of low-voltage electrical currents include household electric machines and outlets. Voltage is a way to measure electricity. High-voltage currents are usually found outside, such as in electric wires, cables, and lightning.
  
  
• When your child is burned, his tissue gets damaged and begins to die. He may have a fast heartbeat, reddish urine, or be dizzy and confused. He may have trouble moving or breathing. Your child may need different kinds of surgeries to treat his burn wounds. He may also need extra fluid or blood. With treatment, your child may have less pain or infections caused by germs called bacteria. Your child may have less tissue damage and he may feel better about his appearance. Your child may be able to return to school or his normal daily activities sooner than without treatment.

CARE AGREEMENT:

You have the right to help plan your child's care. To help with this plan, you must learn about your child's health condition and how it may be treated. You can then discuss treatment options with your child's caregivers. Work with them to decide what care may be used to treat your child.

RISKS:

• Your child may have pain when his bandages are changed. Surgery to remove dead tissue may cause your child pain or an infection. Your child may get too much fluid in his body from liquids he is given. Your child's scars may itch or become thick and raised. If thick scars go over joints (where two bones meet), your child may have trouble moving. If your child has an amputation, then he may feel a sense of pain in the missing limb. If your child had a skin graft, it may fail, leaving him with dead or infected tissue. Your child may have bleeding that does not stop and he may need a blood transfusion.
  
  
• With or without treatment, your child's burned skin may be painful or become infected. Your child's muscles may twitch or become smaller, making it hard to move parts of his body. Your child's organs and tissue may be damaged by compartment syndrome (too much pressure in his body). He may have eyesight or hearing problems. Your child may need to have an amputation if a limb has too much dead tissue. Your child's heart, brain, or lungs may stop working. Your child may die. Call your child's caregiver if you have concerns or questions about your child's surgery, condition, or care.

WHILE YOU ARE HERE:

Informed consent: You have the right to understand your child's health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your child's condition. Your child's caregiver should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives your child's caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to your child. Before giving your consent, make sure all your questions have been answered so that you understand what may happen to your child.

Tubes:

• IV: An IV is a tiny tube placed in your child's vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• CVP line: A CVP line is also called a central line. It is an IV catheter or tube. It is put into a large blood vessel near your child's neck, groin, or near his collarbone. The CVP line may be used to give medicines, draw blood, or to check your child's heart.
  
  
• NG tube: This is also called a nasogastric tube. An NG tube is put down your child's nose and into his stomach. An NG tube keeps air and fluid out of the stomach during surgery. It is usually taken out shortly after surgery.

Medicine:

• Antibiotics: This medicine may help your child fight infections. This medicine may be put on your child's skin before his burn is bandaged. Your child may also get antibiotics as a pill, shot, or in his IV. Antibiotics may have silver in it to help fight infection and help your child's burn heal faster. Silver medicine may be placed on your child's skin as an ointment or his bandages may contain silver.
  
  
• Pain medicine: Caregivers may give medicine to decrease your child's pain. Tell a caregiver if your child's pain does not go away or comes back after taking this medicine. Pain medicine can have side effects. Tell a caregiver if your child has trouble breathing, is very sleepy, or has an upset stomach. Tell a caregiver if your child is allergic to any medicine.
  
  
• Heart medicine: This medicine may be given to make your child's heart beat stronger or more regularly. There are many different kinds of heart medicines. Talk with caregivers to find out what your child's medicine is and why he is taking it.
  
  
• Diuretics: This medicine may be given to help your child's body and lungs get rid of extra fluid. This can help your child breathe easier. Diuretics may make your child urinate more often.
  
  
• Steroid medicine: Steroid medicine may be given to decrease pain and swelling. It may help your child's muscles become stronger. Your caregiver may put steroids on your child's skin as an ointment. He may also give steroids to your child as a pill, shot, or in his IV. This medicine can help a lot but may also have side effects. Be sure you understand why your child needs steroids. Do not stop giving this medicine without your child's caregivers OK. Stopping steroid medicine without your child's caregiver's OK may cause problems.
  
  
• Tetanus shot: This is medicine to keep your child from getting tetanus (lock jaw). It is given as a shot. Your child should have a tetanus shot if he has not had one in the past 5 to 10 years. Your child's arm can get red, swollen, and sore after getting this shot. Ask your child's caregiver for more information about protection against tetanus.

Monitoring:

• Intake and output (I&O):
  
  
  • Your child's caregiver may need to know how much liquid your child is getting and urinating. Caregivers may also want to know how much your child eats and if he had a bowel movement (BM).
    
    
  • Your child may need to urinate into a container in bed or in the toilet. A caregiver will then measure the amount of urine. If your child wears diapers, save them so a caregiver can weigh them. Do not throw away diapers or flush urine down the toilet before asking your child's caregiver.
  
  
• Neurologic signs: These are also called neuro signs, neuro checks, or neuro status. A caregiver may check your child's eyes, memory, and how easily your child wakes up. The strength of your child's arms, hands, legs, and feet may also be checked. These signs may tell caregivers how your child's brain is working.
  
  
• Pulse oximeter: A pulse oximeter is a machine that tells caregivers how much oxygen is in your child's blood. A cord with a clip or sticky strip is placed on your child's foot, toe, hand, finger, or earlobe. The other end of the cord is hooked to a machine. Tell a caregiver if the sticky strip or clip comes off of your child. The machine will alarm if the machine cannot read the oxygen level or if your child needs more oxygen. Tell a caregiver if the machine is alarming. Never turn the pulse oximeter off.
  
  
• Vital signs: This includes taking your child's temperature, blood pressure, pulse (counting his heartbeat), and respirations (counting his breaths). To take your child's blood pressure, a cuff is put on his arm and tightened. The cuff is attached to a machine which gives your child's blood pressure reading. Caregivers may listen to your child's heart and lungs by using a stethoscope. Your child's vital signs are taken so caregivers can see how he is doing.

Tests:

• Blood and urine tests: Your child may need blood or urine tests. These tests help your caregiver check for damage to your child's muscles, heart, and other organs. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV. An IV is a tiny tube placed in your child's vein for giving medicine or liquids. Your child may need to have these tests more than once.
  
  
• Heart monitor: This is also called an ECG, electrocardiogram, or telemetry. Three or five sticky pads are placed on your child's chest. Each pad has a wire leading to a TV-type screen or to a small portable box (telemetry unit). This screen or box shows a picture of your child's heartbeat. Caregivers watch this picture to make sure your child's heart is doing OK.
  
  
• Imaging tests: These tests help your child's caregiver see images (pictures) that show how your child's body is doing. Your child may need any of the following:
  
  
  • CT scan: This is also called a CAT scan. A special x-ray machine uses a computer to take pictures of your child's body. It may be used to look at your child's bones, muscles, brain, body organs, and blood vessels. Your child may be given dye by mouth or in an IV before the pictures are taken. The dye may help your child's caregiver see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell the caregiver if your child is allergic to shellfish, or has other allergies or medical conditions.
    
    
  • MRI: This test is called magnetic resonance imaging. During the MRI, 3-D (three-dimensional) pictures are taken of your child's body. An MRI may be used to look at your child's brain, muscles, joints, bones, or blood vessels. Your child will need to lie still during his MRI. Never enter the MRI room with an oxygen tank, wrist watch, or any other metal objects. This can cause serious injury.
    
    
  • Scintigraphy: Scintigraphy is a test that takes pictures of your child's body. Scintigraphy may help your child's caregiver find dead tissue in your child's body. Scintigraphy may also help him figure out how much dead tissue needs to be removed during surgery.
    
    
  • Ultrasound: An ultrasound is a simple test that looks inside your child's body. Sound waves are used to show pictures of his organs and tissue on a TV-like screen. Your child may also have a Doppler ultrasound or duplex scan done. With these tests, your child's caregiver will see how well blood flows in your child's blood vessels.

Treatment options:

• Fluid therapy: Your child may need more fluid in his body. Your child's caregiver may give him intravenous (IV) fluids. An IV is a tube placed in your child's vein for giving medicine or liquids. This tube is capped or connected to tubing and the liquid. Your child's caregiver may also give your child extra nutrition through his IV tubing.
  
  
• Pressure garments: Your child may need to wear special pressure garments (clothing) over his burns. Pressure garments may help keep thick scars from forming. Your child may need to wear these for most of the day. Pressure garments are custom made to fit your child. Ask your child's caregiver for more information about pressure garments.
  
  
• Wound care: Your child's burns will be bandaged to keep the area moist and clean. A special medicine may be put on your child's burn. Your child's caregiver may then cover your child's burn with a bandage called gauze. Your child's dressings will be changed at least twice a day. During dressing changes, your child's burn may be cleaned with soap and water.
  
  
• Surgery: Your child may need more than one surgery. More than one surgery may be done at the same time or in different stages.
  
  
  • Debridement: This is surgery to remove damaged tissue from your child's body. Your child's caregiver will remove enough tissue until he can see healthy tissue. Caregivers may do this to avoid infection, decrease inflammation (pain and swelling), and improve healing. Your child may need to have this surgery more than once.
    
    
  • Escharotomy: In an escharotomy, your child's caregiver will remove dead tissue from your child's body. This surgery may decrease your child's chances of getting an infection and more damage to his skin.
    
    
  • Fasciotomy: Fasciotomy is surgery to cut into your child's fascia (strong tissue that divides your child's body into sections). This surgery is done to release pressure that is caused by swollen muscles. With fasciotomy, your child may be less likely to have more damage to his nerves, organs, or tissue.
    
    
  • Skin grafts and flaps: Your child's caregiver may place grafts to cover or replace the skin or tissue your child lost from electrical burns. Grafts may come from other healthy tissue in your child's body. It may also be natural or man-made material. A graft can help close your child's wounds, prevent an infection, or decrease scarring. Skin flap surgery is done to fix large wounds that cannot be closed by skin grafting. A skin flap is skin and tissue that is moved while still attached to cover the wound area. Skin flaps may improve the appearance of your skin.
    
    
  • Arthroplasty: Your child may need arthroplasty if he has damaged joints. He may also need skin flaps to cover any joints that are exposed (seen).
    
    
  • Nerve release (decompression): A nerve in your child's body may be compressed (squeezed) after he got burned. Your child may need this surgery to release the pressure on this nerve. This may help prevent your child's injury from getting worse.
    
    
  • Amputation: Amputation is removing one of your child's body limbs, such as a finger, arm, shoulder, or leg. Your child may need this surgery if there is too much dead tissue in his limbs. Your child may be measured for an artificial (fake) limb to use instead of his amputated limb.
    
    
  • Reconstructive surgery: This is also called plastic or cosmetic surgery. Reconstructive surgery may help your child's skin look less burned. It may also help his body be less deformed.
  
  
• Blood transfusion: A blood transfusion may be needed if your child loses too much blood. This is donated whole blood, or parts of blood your child may get through an IV. You may be worried that your child will get AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile Virus. If you refuse a blood transfusion for your child, his condition may get worse, and he may die.

Therapy options: Your child may need to have rehabilitation (rehab). Rehab uses different therapists to help your child function better.

• Physical therapy: A physical therapist may help your child with special exercises. These exercises may help your child's muscles and bones become stronger. Your child may move his limbs in different directions by himself or with the help of his caregiver. By exercising your child's joints, a physical therapist may help find where thick scars are forming. He may also help your child's joints function better. Your child may need to wear splints or casts to help prevent his muscles from shrinking. This may help prevent his joints and bones from becoming deformed.
  
  
• Massage therapy: A massage therapist may help your child feel less pain. Massage therapy may also help prevent thick scars from forming.
  
  
• Speech therapy: A speech therapist may work with your child to help him talk.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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