Electrical Injuries in Emergency Medicine Follow-up

  • Author: Tracy A Cushing, MD, MPH, FACEP, FAWM; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 12, 2010
 

Further Inpatient Care

Inpatient care is required for patients with anything other than minor low-voltage injuries. Burn and trauma care, preferably at a specialized center, should be instituted early. Any patients with cardiac arrest, loss of consciousness, abnormal ECG, hypoxia, chest pain, dysrhythmias, and significant burns or traumatic injuries must be admitted.

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Further Outpatient Care

Patients exposed to low-voltage electrical sources who are otherwise completely asymptomatic with a normal physical examination can often be discharged from the emergency department.

Patients with minor burns or mild symptoms can be observed for several hours and discharged if their symptoms resolve and they do not have elevated CPK/myoglobinuria. Patients should be made aware of possible long-term neurologic or ocular effects of electrical injuries, and have follow-up available as needed. Any patient with significant hand burns should be referred to a hand specialist for close follow-up.

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Transfer

All patients with a history of exposure to high-voltage electricity and patients with significant burns should be transferred to a specialized burn center for further inpatient treatment and rehabilitation.

Pediatric patients with significant oral burns should be transferred to a pediatric burn center. Patients with minor oral burns and close follow-up can be discharged.

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Deterrence/Prevention

Prevention of high-voltage electrical injuries requires ongoing public education about potential hazards, and targeted education to individuals in construction trades, those using cranes and lifts, or those exposed to the extreme danger of overhead power lines. One study found particularly high rates of electrical injuries in cable splicers, electricians, line workers, and substation operators.[30] Prevention strategies and occupational safety changes should be targeted to these high-risk occupations.

Prevention of household exposures requires public education about child protection, outlet covers, and appliance safety. Appliances that produce a shock should not be used until professionally repaired. Encourage use of GFCIs on all outlets but especially bathrooms, kitchens, and exterior outlets.

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Complications

Low-voltage

If no significant burns are present and if consciousness returns before arriving to or in the ED, full recovery is expected. Rare persistent arrhythmias have been reported.

Persistence of unconsciousness carries a worse prognosis, and full recovery is not expected after 24 hours of unconsciousness.

With proper treatment, the disfigurement of low-voltage mouth injuries can be minimized. Scarring is always present.

High-voltage

Survival with massive burns is now the rule rather than the exception. However, there are still very high rates of amputation and significant morbidity from traumatic injuries and burns.

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Prognosis

For those without prolonged unconsciousness or cardiac arrest, the prognosis for recovery is excellent.

Burns and traumatic injuries continue to cause the majority of the morbidity and mortality from electrical injuries.

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Patient Education

For excellent patient education resources, visit eMedicine's Burns Center. Also see eMedicine's patient education article Thermal (Heat or Fire) Burns.

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Contributor Information and Disclosures
Author

Tracy A Cushing, MD, MPH, FACEP, FAWM  Assistant Professor, Department of Emergency Medicine, University of Colorado School of Medicine; Attending Physician, Denver Health Medical Center

Tracy A Cushing, MD, MPH, FACEP, FAWM is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Ronald K Wright, MD, JD  Associate Professor (Retired), Department of Pathology, University of Miami School of Medicine; Private Practice, Forensic Pathology

Ronald K Wright, MD, JD is a member of the following medical societies: American Academy of Forensic Sciences, American Medical Association, American Society for Clinical Pathology, College of American Pathologists, and National Association of Medical Examiners

Disclosure: Nothing to disclose.

Specialty Editor Board

Jerry Balentine, DO  Professor of Emergency Medicine, New York College of Osteopathic Medicine; Executive Vice President, Chief Medical Officer, Attending Physician in Department of Emergency Medicine, St Barnabas Hospital

Jerry Balentine, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American College of Physician Executives, American Osteopathic Association, and New York Academy of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eric L Legome, MD  Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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Arcing electrical burns through the shoe around the rubber sole. High-voltage (7600 V) alternating current nominal. Note cratering.
Contact electrical burn. This was the ground of a 120-V alternating current nominal circuit. Note vesicle with surrounding erythema. Note thermal and contact electrical burns cannot be distinguished easily.
Contact electrical burns, 120-V alternating current nominal. The right knee was the energized side, and the left was ground. These are contact burns and are difficult to distinguish from thermal burns. Note entrance and exit are not viable concepts in alternating current.
Electrical burns to the hand.
Electrical burns to the foot.
High-voltage electrical burns to the chest.
Superficial electrical burns to the knees (flash/ferning).
Energized site of low-voltage electrical burn in a 50-year-old electrician.
Grounded sites of high-voltage injury on the chest of a 16-year-old boy who climbed up an electric pole.
Energized site of the high-voltage injury depicted in Media File 9 (16-year-old boy who climbed up an electric pole).
Entrance site of a low-voltage injury.
Grounded sites of a low-voltage injury in a 33-year-old male suicide patient.
Grounded site of a low-voltage injury in the same 33-year-old male patient depicted in Media File 12.
Grounded sites of low-voltage injury on the feet.
A histologic picture of an electrical burn showing elongated pyknotic keratinocyte nuclei with vertical streaming and homogenization of the dermal collagen (40X). Courtesy of Elizabeth Satter, MD.
Table 1. Physiologic Effects of Different Electrical Currents
Effect Current (milliamps)
Tingling sensation/perception1-4
Let-go current – Children3-4
Let-go current - Women6-8
Let-go current – Men7-9
Skeletal muscle tetany16-20
Respiratory muscle paralysis20-50
Ventricular fibrillation50-120
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