Operating rooms pose electrical shock hazards due to the abundance of electrical equipment, anesthetized patients who cannot move away from shocks, and the presence of fluids. Electrical shock occurs when a person completes a circuit between a voltage source and allows current to flow through their body, which can disrupt organ functions or cause burns. The severity of shock depends on current amplitude and duration, with alternating current posing more danger than direct current. Macro shocks involve large currents that can reach the heart through tissues, while microshocks involve small currents that can directly stimulate the heart through conduits like catheters. Proper grounding pad placement and equipment maintenance can help reduce electrical shock risks in operating rooms.

1. Presenter: Sujata Walode
Msc (OT & AT)
MGM SBSA

2. If electrical system are not properly wired, persons can be
electrocuted
• DC – less dangerous
• AC– 3 times as dangerous as DC
ELECTRICAL SHOCK HAZARDS

3. Why electricity is particularly
dangerous in the operating
room ??
1. Operating rooms are full
of electrical equipment.
ELECTRICAL SHOCK HAZARDS

4. 2. Anaesthetized patients
are "helpless" and can't
move awayfrom a
shock.

5. 3. Operating rooms are full of
fluids

6. 4. Electrical current is invisible

7. Electrical accidents or shocks occur
when a person becomes part of, or
completes, an electrical circuit.
To receive a shock,
1. one must contact the electrical
circuit at two points, i.e., a closed
loop must exist
2. and there must be a voltage source
that causes the current to flow
through an individual.

8. CONSEQUENCES OF PASSAGE OF CURRENT
THROUGH THE BODY
First, the electrical current can disrupt the normal
electrical function of cells.
Depending on its magnitude, the current can
• Contract muscles,
• Alter brain function,
• Paralyze respiration, or
• Disrupt normal heart function, leading to ventricular fibrillation

9. The second mechanism involves the dissipation of electrical
energy throughout the body's tissues.
An electrical current passing through any resistance raises
the temperature of that substance.
If enough thermal energy is released, the temperature will
rise sufficiently to produce a burn.

10. Electrical burns and electrically initiated burns
• Threetypes
– Carbonization of skin (from burns at very high
temperaturesof1,000°C)
– Flameburns
– Direct heating of tissues produce coagulation and
necrosisat entry andexit points andassociated injury in
muscleandBV.

11. The severity of an electrical shock is
determined by:
1. The amount of current (no of
amperes), which in turn, will
depend upon voltage source and
skin resistance of the person
2. The duration of the current flow
Skin resistance varies from a few
thousands to 1 million ohms.

12. Electric shock
Macro shock Micro shock
Note: While both can be fatal, when we talk about macro shock versus micro shock, we
generally are referring to risk of ventricular fibrillation.

13. Ventricular fibrillation (VF) causing
current can reach the heart in two ways:
One route it can take is to go through
the skin and tissues to reach the heart.
The skin normally has a very high
resistance to current flow.
Therefore, for “enough” current to reach
the heart and cause ventricular
fibrillation (VF), the current given to the
skin has to be fairly large.

14. Macro shock refers to large amounts of current flowing
through a person, which can cause harm or death.
If applied directly to the heart, it will also cause VF.

15. The other wayis to givecurrent
straight to the heart without it
having to go through the skin and
tissues.
Ashock may be given directly to
the heart by something that
conducts electricity very well, such
as an pace maker wire or a
conducting fluid filled tube such as
a central venous pressure (CVP)
catheter.

16. The shock current that goes straight to the heart bypasses the high
resistance skin path and follows a low resistance pathway straight
to the heart.
Because the resistance is low,only a small current is needed to
cause VF.
Such type of individuals who has an external conduit that is in
direct contact with the heart are known as ELECTRICALLY
SUSCEPTIBLE PATIENT.
Micro shock refers to very small amounts of current and applies
only to electrically susceptible patient

17. Macro shock: Large
current able to go
through skin and
tissues to heart
Micro shock: Small
current able to go
through direct
connection to heart
IN SUMMARY

18. Place dispersive pad over a well-vascularized muscle mass
Avoid placing grounding pad over bony prominences, hairy sites, scar
tissue, excess adipose tissue
Place grounding pad as close to the surgical site as possible
Grounding pad should be placed so that the entire surface of the pad is
in uniform contact with the pad site
Avoid any tenting or gaps where parts of the pad are not in contact with
the patient
SAFETY MEASURES

19. SAFETY MEASURES
Inspect machine for frayed or broken wires before use.
Active electrode wire should be free of kinks
Use lowest setting that is effective

20. SAFETY MEASURES
Recommended practice: keep ESU pencil in non-conductive
holder when not in use - this prevents accidental activation
Prep or irrigation solutions should not pool near the grounding
pad
Don’t allow ESU pedal to stand in pool of liquid

21. SAFETY MEASURES
No part of the patient should be touching any grounded metal
objects (IV pole, Mayo stand, metal surfaces of OR bed)
Electrical current always seeks the path of least resistance—
patient might have an alternate site burn where their body is in
contact with metal

22. THANK YOU