This book was motivated by the need to consolidate and review information on tissue injury in victims of electrical trauma so that the pathophysiology and clinical manifestations might better be understood and integrated. The physiological manifestations of electrical trauma range from the simple to the complex and from the innocuous to the fatal. This variation relates to large differences in victim exposure to many factors, including contact voltage, contact duration, presence of clothing in the current path, and the direction of the circuit path through the victim. These differences along with a limited knowledge of the pathophysiology contribute to the present state of confusion that exists among medical staff caring for victims of electrical shock. As a result, progress toward a rational approach to electrical trauma has been relatively slow.

Over the past half-century, survival following major trauma has steadily improved as the capability to perform vital physiologic support has increased; however, little progress has been made in improving the survival of damaged tissue. Limb amputation rates among victims experiencing direct electrical contact are quite high and have remained at a near constant level over the past several decades. At least 85% of victims who survive this ordeal are left disabled. We hold the view that rational therapy to salvage damaged tissue must be based on a detailed understanding of the responsible cellular derangements which ultimately lead to arrest of cell function. Thus, the first purpose of this book is to review the underlying physicochemical mechanisms responsible for tissue damage in electrical injury victims.