HWN Suggests

Air Care Series: Electrocution

The evaluation and management of patients who have suffered electrocution is challenging, as presentations range from asymptomatic to refractory cardiac arrest. Important historical features include type of current (AC or DC), voltage, and duration of exposure. Electrocuted patients are especially susceptible to cardiac arrhythmias, neurologic injury, rhabdomyolysis, and compartment syndrome. Even in the well-appearing patient, a thorough evaluation and high index of suspicion for injury is paramount, as electrocuted patients often have atypical injury patterns.

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  Electrical Injuries

Who should I admit and who can I send home? Low voltage, asymptomatic- Do nothing and discharge. Low voltage, mild symptoms- Monitor and can discharge, if EKG and UA normal. High voltage (>1000V)- Admit for monitoring.

 Acute Care of the Electrocuted Patient

Arrhythmia is a frequent cause of death in electrocution. While any type of electrocution can cause any type of arrhythmia, DC/lightning tends to induce asystole, while AC tends to cause ventricular fibrillation. Most malignant arrhythmias occur very shortly following the event. Other non-life threatening arrhythmias can occur within a few hours of the event, most of which self-resolve.

 Electrical Injuries – The Tip of the Iceberg

Electrical injuries are rare, representing less than 1% of burn center admissions. So there is a paucity of robust evidence for the management of these patients.

 Electrical Injuries: Hertz So Bad

Injury from electrical burns can be subtle. Think of patients as having occult multi-trauma. Be thorough in history and examination. Plan to re-examine either during observation in the ED, or in close outpatient follow-up.

 Electrical Injury

Although AC is considered to be a far more efficient way of generating and distributing electricity, it is also more dangerous than DC (approximately three times) because it causes tetanic muscle contractions that prolong the contact of the victim with the source.

Articles of Interest

ZAP! Unexpected Electrical Injury: A Case Report

The mechanism of an electrical injury varies with age, with younger children accounting for household electrical injuries via cords and outlets, older children via high-voltage power lines, and adults via work-related accidents. Two-thirds of all electrical injuries occur in electrical and construction workers.

Electrical Injuries in the Emergency Department: An Evidence-Based Review

Electrical injuries can affect every organ system and can cause thermal, electrophysiological, traumatic, and metabolic derangement. Patients may resemble ordinary cardiac, trauma, or burn victims, making recognition challenging, and history is sometimes difficult to obtain. Management of these cases has evolved over time, especially in recommendations for cardiac monitoring and ear, nose, and throat (ENT) care for pediatric oral electrical burns.

Electrical Injuries in the Emergency Department: An Evidence-Based Review

There is suggestive, but not definitive, evidence that cardiac monitoring is not necessary for any patients without ECG changes, regardless of voltage level, but no well-designed prospective trials were found. The most recent literature continues to recommend cardiac monitoring for patients with a high-voltage injury or initial ECG abnormalities.

Electrical Injury and Burn Care: A Review of Best Practices

Electrical injuries are uncommon but can be dangerous and deadly, not only for patients but also for responders.1–5 This article covers the nature of electricity, basics of electrical injury, general patient assessment and initial care.

Electrocution!

Always get an EKG!

EM@3AM – Electrical Injuries

Asymptomatic patient having experienced a low voltage electrical injury => discharge with return precautions (delayed neurologic symptoms may occur => portends a poor outcome).

Emergent Care of Lightning and Electrical Injuries

High-voltage electrical injuries may be devastating, with extensive burns, cardiac arrest, amputations, and long, complicated hospitalizations. Low-voltage injuries, after other pathologic and high-voltage sources are ruled out, tend to be rather benign acutely although they may have significant long-term morbidity, including chronic pain syndromes.

Low-voltage electric shock – proposed new recommendations

Patients who are exposed to low-voltage currents without experiencing an electric shock in the upper body do not need further investigation if they have no or minimal symptoms and normal findings at a general clinical examination.

Resources

Deranged Physiology

Severity of the burn cannot be assessed externally: the damage is frequently to deep structures, and there may be severe coagulative myonecrosis with minimal external skin damage. Normal burns staging does not apply.

Life in the Fastlane

Management of severe electrical injuries.

StatPearls

There are four main types of electrical injuries: flash, flame, lightning, and true. Flash injuries, caused by an arc flash, are typically associated with superficial burns, as no electrical current travels past the skin.

WikEM

Tissue damage occurs via electrical energy (becomes thermal energy once it enters the body) and mechanical injury from trauma Skin, bone, tendon all have very high resistance. Muscle, nerves, vasculature have lower resistance, more often damaged.