eMedicine Specialties > Emergency Medicine > Environmental

Electrical Injuries: Follow-up

Author: Tracy A Cushing, MD, MPH, Instructor in Medicine, Department of Emergency Medicine, Harvard Medical School; Attending Physician, Department of Emergency Medicine, Mount Auburn Hospital
Coauthor(s): Ronald K Wright, MD, JD, Associate Professor (Retired), Department of Pathology, University of Miami School of Medicine; Private Practice, Forensic Pathology
Contributor Information and Disclosures

Updated: Oct 7, 2009

Follow-up

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.

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.

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. 

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. 
 
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.

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.

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. 

Patient Education

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

Miscellaneous

Medicolegal Pitfalls

Litigation concerning occupational injuries is to be expected, but suits against practitioners in such cases are rare. Detailed documentation of the presence of electrical burns is extremely helpful, including diagrams. Obtain photographic records of injuries, with proper consent, if possible. 

 


More on Electrical Injuries

Overview: Electrical Injuries
Differential Diagnoses & Workup: Electrical Injuries
Treatment & Medication: Electrical Injuries
Follow-up: Electrical Injuries
Multimedia: Electrical Injuries
References
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References

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Further Reading

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Keywords

electrical injury, electrical shock, electrical burns, lightning injury, electrocution, low-voltage injury, high-voltage injury, nerve depolarization, muscle depolarization, alternating current injury, AC injury, thermal burns, electrical flashes, direct current electrical injuries, DC electrical injuries, flash burns, arc burns, contact burns, internal electrical injury, external electrical energy, burn treatment, electrical injury treatment, myoglobinuria, myoglobinemia, lightning strike

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Contributor Information and Disclosures

Author

Tracy A Cushing, MD, MPH, Instructor in Medicine, Department of Emergency Medicine, Harvard Medical School; Attending Physician, Department of Emergency Medicine, Mount Auburn Hospital
Tracy A Cushing, MD, MPH 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 College of Legal Medicine, American Medical Association, American Society for Clinical Pathology, College of American Pathologists, and National Association of Medical Examiners
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eric L Legome, MD, Chair, Department of Emergency Medicine, St Vincent's Hospital Manhattan; 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.

CME Editor

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

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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