When this patient reached Arihant Multispeciality Hospital, a high-voltage electric current had burned 74% of his body. That is nearly three-quarters of his skin. His doctors put the odds of surviving a burn like his at about one in a thousand.
Two and a half months later, he was sitting up, talking, and raising both arms for the camera. This is what an injury like his does to the body, and what it took to get him there.
What losing 74% of your skin means
Skin is the body's largest organ, and it does far more than cover us. It holds in the body's fluids, keeps its temperature steady, and is the main barrier against infection. Doctors measure a burn by the share of the body's surface it covers. Once a burn passes about 20% in an adult, the patient needs formal fluid resuscitation: carefully measured fluids through a drip. At 74%, almost every one of skin's jobs has failed at once.
- Burn shock. In the first day or two, fluid leaks out of blood vessels throughout the body, not only at the burn. Blood pressure falls, and the kidneys and other organs can fail unless the lost fluid is replaced, hour by hour.
- Infection. Burned skin no longer keeps bacteria out, and wounds this large take weeks to close. Every day they stay open, infection can spread into the blood (sepsis), which is one of the gravest dangers once the first days are survived.
- Heat loss. Without skin to hold it in, the body loses heat quickly, so a burn patient can become dangerously cold even in a warm room.
- A body in overdrive. After a major burn the body turns hypermetabolic, burning energy and breaking down its own muscle far faster than normal, for weeks. Nutrition becomes part of the treatment.
- Pain, and weeks of it: in the wounds, in dressing changes, and in the surgery needed to close them.
Why an electrical burn is worse than it looks
A burn from fire starts at the skin and works inward. An electrical burn often works the other way. High-voltage current enters at one point, usually a hand, travels through the body, and leaves at another, most often a foot. Along the way it heats nerves, blood vessels and muscle from the inside. The marks on the skin can be small while the damage underneath is severe. The size of the skin burn does not tell doctors how badly the tissue beneath has been injured, so every electrical injury is treated as deeper than it looks.
- The heart. Current that crosses the chest, as it does from hand to hand or hand to foot, can throw the heart into a dangerous rhythm. Patients are watched on a heart monitor.
- The kidneys. Damaged muscle releases a protein called myoglobin into the blood, and it can block and injure the kidneys. Doctors keep urine flowing with generous fluids, and measure it closely.
- Fluid needs. The usual formulas for burn fluids are based on the burned skin, so they underestimate what an electrical burn needs. Fluids are instead adjusted to how much urine the patient is making.
- The limbs. Muscle swollen inside the tight compartments of an arm or leg can cut off its own blood supply (compartment syndrome). Surgeons may need to open the compartment, and remove dead muscle, to save the limb and protect the kidneys.
- Everything else. The jolt can throw a person from a pole, ladder or roof, or trigger violent muscle spasms, so fractures, spinal and head injuries have to be looked for too.
What it took
No single doctor can carry a patient through a burn like this. At Arihant, the team around him brought together burn specialists, surgeons, anaesthetists, intensivists, the critical care team and the nursing staff, day and night, for about ten weeks. Care for a major burn usually runs in overlapping stages:
- Resuscitation, in the first days: fluids adjusted around the clock, heart monitoring, strong pain relief, and protection for the kidneys.
- Surgery to close the wounds: dead tissue is cut away early, and the wounds are covered with thin grafts of the patient's own healthy skin. Early excision and grafting is one of the main reasons more people now survive large burns. When three-quarters of the body is burned, there is little healthy skin left to graft from, so the work is done in stages, over several operations.
- Intensive care in between: dressings, infection control, nutrition, and close watch on every organ.
- Rehabilitation: physiotherapy starts once the grafts have taken, within days, because healing skin tightens and can lock joints in place (contractures). Splints and daily stretching keep the arms and legs working.
Recovery is not only physical. Fear, disturbed sleep and low mood are common after a major burn, and support for the mind is part of the treatment. In his own words, it was a challenging and frightening time. He credits the team's care and the hospital's facilities, and the positive outlook he and his family held on to, with getting him through.
If you see someone get an electric shock
- Do not touch them while they may still be in contact with the current. Switch off the supply at the mains, meter or circuit breaker. Turning off an appliance may not be enough.
- If high-voltage lines are involved (overhead wires, a transformer, a pole), stay at least 6 metres (20 feet) away and keep others back until the electricity board has cut the power.
- If the current cannot be switched off at the mains, move the person away using something dry that does not conduct electricity, such as a wooden broom handle, a chair or a rubber mat. Never use anything wet or metal.
- Call for help: Arihant's emergency line is 0712 665 6666, or dial 108 for an ambulance.
- Once it is safe, check their breathing. If they are unresponsive and not breathing normally, start CPR.
- Cool any burns under cool running water for about twenty minutes. No ice, butter, toothpaste, oil or ointment. Cover loosely with cling film or a clean cloth.
- Do not move their head or neck if they may have fallen.
- Take them to hospital even if the burn looks small. The damage inside, and heart rhythm problems, can be far worse than the skin shows.
Preventing it
- Never try to pull down a kite, clothes or anything else caught in or near an overhead line, and keep ladders, poles and pipes well clear of wires, especially on rooftops and terraces.
- Switch off the supply before any electrical repair, and leave wiring work to a licensed electrician.
- Keep water away from switches, sockets and appliances, and never handle them with wet hands or bare feet on a wet floor.
- Ask your electrician about a residual current circuit breaker (RCCB) for your home. It cuts the power within a fraction of a second if current leaks to earth.
Burns are common in India, and most of them are preventable: according to the World Health Organization, more than a million people in India are moderately or severely burned every year.
Read next
- Burns and scalds: symptoms, first aid and treatment
- Critical care at Arihant
- Emergency medicine, 24 × 7
