The Treatment Challenges and Limitation in High-Voltage Pediatric Electrical Burn at Rural Area

A case of high-voltage pediatric electrical burn involving a fully conscious 13-year old boy who was admitted to the emergency room after being electrocuted by high-voltage power cable, with superficial partial thickness burn over right arm, trunk, and left leg (26% of total body surface area) with cardiac abnormality e.g. tachycardia and non-specific ST depression. Treatments were based on Australian New Zealand Burns Association algorithm with several modifications, i.e. administering lower concentration of oxygen with nasal cannula instead of non-rebreathing mask and intravenous Ketorolac and Metamizole as analgesic instead of morphine due to limitation in infrastructure and knowledge. The patient underwent surgical debridement and strict observation with no signs of abnormality found during hospital stay. Wound dressing consisted of silver sulfadiazine, Sofra-tulle® and dry sterile gauze were used until epithelialization. After the wound healed, the patient resumed wearing elastic bandage and moisturizer on the wound area. The patient was observed daily through 7 days of hospitalization and followed-up for 1 year, achieving normal physiologic function of the affected area but unsatisfactory esthetic result. This case report showed that there is still a lack of burn prevention programs in the rural area, resulted in inadequate first aid application for electrical burn. There is a need for acknowledging and maximizing the implementation of available standardized guidelines e.g. Australian New Zealand Burns Association by giving homogenized training to personnel as well as providing feasible equipment, and then followed by strict monitoring for the patient. The focus of the burn program should also include burn rehabilitation, psychosocial needs and any complaints needing expert opinion in an outpatient setting in addition to adequate burn management for life saving and good wound healing.