Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 37-11: Electrical Injury + Key Features Download Section PDF Listen +++ +++ Essentials of Diagnosis ++ The extent of injury is determined by Amount and type of current Duration and area of exposure Pathway of the current through the body Clinical findings of death are unreliable; therefore, resuscitation must be attempted before assuming the electrical injury victim is dead Skin findings may be misleading, and not indicative of the degree of deeper tissue injury +++ General Considerations ++ With alternating currents (AC) of 25–300 Hz Low voltages (< 220 Hz) tend to produce ventricular fibrillation High voltages (> 1000 Hz) cause respiratory failure Intermediate voltages (220–1000 Hz) cause both More than 100 mA of domestic house current (AC) of 110 V at 60 Hz can cause ventricular fibrillation Direct current (DC) contact is more likely to cause asystole Lightning injuries differ from high-voltage electric shock injuries Lightning usually involves higher voltage It usually has a briefer duration of contact It may cause asystole, nervous system injury, and multisystem pathologic involvement Electrical burns are of three distinct types Flash (arcing) burns Flame (clothing) burns Direct heating effect of tissues by the electric current + Clinical Findings Download Section PDF Listen +++ +++ Symptoms and Signs ++ May vary from tingling, superficial skin burns, and myalgias to paralysis, massive tissue damage, or death Skin damage does not correlate with the degree of injury Not all electrical injuries cause skin damage Only very minor skin damage may be present with massive internal injuries Lesions caused by direct heating of tissues are usually sharply demarcated, round or oval, painless yellow-brown areas (joule burn) with inflammatory reaction Loss of consciousness + Diagnosis Download Section PDF Listen +++ +++ Laboratory Tests ++ Obtain the following immediately Complete blood count Electrolytes Kidney function tests Liver biochemical tests Creatine phosphokinase or urine myoglobin Urinalysis Cardiac enzymes +++ Diagnostic Procedures ++ Obtain an ECG immediately + Treatment Download Section PDF Listen +++ ++ Pain management with acetaminophen, nonsteroidal anti-inflammatory drugs, opioids +++ Therapeutic Procedures +++ Emergency measures ++ Separate patient from the electric current before initiation of CPR or other treatments; the rescuer must be protected Turn off the power, sever the wire with a dry wooden-handled ax, make a proper ground to divert the electric current, or separate the victim using nonconductive materials such as dry clothing Resuscitation must be initiated on all victims of electrical injury since clinical findings are deceptive +++ Hospital measures ++ Evaluate for Hidden injury (eg, ophthalmic, otologic, muscular, compartment syndromes) Organ injury (myocardium, liver, kidney, pancreas) Blunt trauma Dehydration Skin burns Hypertension Posttraumatic stress disorder Acid-base disturbances Neurologic damage Fluid resuscitation is important to maintain adequate urinary output (0.5 mL/kg/h if no myoglobinuria is present, 1.0 mL/kg/h if myoglobinuria is present) Early debridement of devitalized tissues and tetanus prophylaxis may reduce the risks of infection In pregnant patients exposed to high voltage injury, the fetus may sustain intrauterine growth retardation, fetal distress, and fetal demise; fetal monitoring is recommended + Outcome Download Section PDF Listen +++ +++ Complications ++ Cardiac or respiratory arrest Dysrhythmias Autonomic dysfunction (resulting in pupils that are fixed, dilated, or asymmetric) Paralysis Headache Altered mental status Seizures Vascular injury Tissue edema and necrosis Compartment syndrome Fractures from falls or muscle contractions Pneumothorax Rhabdomyolysis Acute kidney injury Hypovolemia from third spacing Ruptured ear drums Infections Acute or delayed cataract formation Sepsis Gangrene requiring limb amputation +++ Prognosis ++ Prognosis depends on the degree and location of electrical injury, initial tissue damage, associated injuries, comorbidities, and complications Psychiatric support may be necessary following electrical injury +++ When to Refer ++ Fasciotomy may be needed for compartment syndrome Tissue debridement of devitalized tissues may be needed Microvascular reconstruction may be required +++ When to Admit ++ Indications for hospitalization High voltage exposure Dysrhythmia or ECG changes Large burn Neurologic, pulmonary, or cardiac symptoms Suspicion of significant deep tissue or organ damage Transthoracic current pathway History of cardiac disease or other significant comorbidities or injuries Need for surgery + References Download Section PDF Listen +++ + +Clark AT et al. JAMA patient page. Electrical injury. JAMA. 2017 Sep 26;318(12):1198. [PubMed: 28973623] + +Dechent D et al. Direct current electrical injuries: a systematic review of case reports and case series. Burns. 2020 Mar;46(2):267–78. [PubMed: 31208768] + +Gentges J et al. Electrical injuries in the emergency department: an evidence-based review. Emerg Med Pract. 2018 Nov;20(11):1–20. [PubMed: 30358379] + +Gille J et al. Electrical injury—a dual center analysis of patient characteristics, therapeutic specifics and outcome predictors. Scand J Trauma Resusc Emerg Med. 2018 May 31;26(1):43. [PubMed: 29855384] + +Handa A et al. Electrical injury: an unusual cause of pneumothorax and a review of literature. BMJ Case Rep. 2019 Aug 26;12(8):e230590. [PubMed: 31451468] + +Pilecky D et al. Risk of cardiac arrhythmias after electrical accident: a single-center study of 480 patients. Clin Res Cardiol. 2019 Aug;108(8):901–8. [PubMed: 30771067] + +Stockly OR et al. The impact of electrical injuries on long-term outcomes: a Burn Model System National Database study. Burns. 2020 Mar;46(2):352–9. [PubMed: 31420267] + +Waldmann V et al. Electrical cardiac injuries: current concepts and management. Eur Heart J. 2018 Apr 21;39(16):1459–65. [PubMed: 28444167]