Electrical injury

Last reviewed: 28 Aug 2022

Last updated: 28 Aug 2020

Electrical injury may be caused by exposure to high- or low-voltage electricity or lightning. Electronic control devices (e.g., Tasers) may also cause a mild electrical injury.

Recognition of arrhythmias is an essential element of the initial evaluation of electrical injury.

Most electrical shocks cause no injury.

May cause electrical and thermal burns, and secondary injuries due to a fall, or severe tetany. Pressure wave injury may occur subsequent to electrical blast.

Survivors of high-voltage electrical injury or lightning strikes can have long-term sequelae, and regular follow-up is essential.

Definition

Electrical injuries may be caused by exposure to natural lightning or electricity in the home or workplace. Electrical injury includes electrocution, electric shock, burns, and secondary injuries.

History and exam

Key diagnostic factors

loss of consciousness
prehospital CPR or defibrillation
tachycardia
hypotension
low Glasgow coma score
burns
physical injuries

More key diagnostic factors

Other diagnostic factors

diminished peripheral pulses and poor capillary refill
low core body temperature
confusion
paralysis

Other diagnostic factors

Risk factors

age <6 years
construction industry workers
male sex
participation in outdoor sports

More risk factors

Diagnostic investigations

1st investigations to order

ECG
CBC
electrolytes
LFTs
coagulation studies
creatine kinase
urine myoglobin
cardiac enzymes (CK-MB and troponin)
toxicology screen
CXR

More 1st investigations to order

Investigations to consider

plain x-rays
head CT
head MRI
compartment pressure measurements

More investigations to consider

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Baljit Dheansa, MBBS, FRCS, MSc, FRCS (Plast)

Consultant Burns, Plastic & Reconstructive Surgeon

Honorary Senior Lecturer

Queen Victoria Hospital NHS Foundation Trust

West Sussex

Disclosures

BD receives reimbursement for his time as a member of the data monitoring committee for a trial using Nexobrid, a product used in treating burns.

Juan Enrique Berner, MD, MSc, MRCS

Senior Fellow in Plastic Surgery

Queen Victoria Hospital NHS Foundation Trust

West Sussex

Disclosures

JEB declares that he has no competing interests.

Acknowledgements

Mr Dheansa and Dr Berner would like to gratefully acknowledge Dr T Grant Phillips, a previous contributor to this topic. TGP declares that he has no competing interests.

Peer reviewers

Stephen J. Ritz, DO

UPMC St. Margaret Family Medicine Residency and Faculty Development Fellowship

Osteopathic Family Practice/Rotating Internship Program

Pittsburgh

Disclosures

SJR declares that he has no competing interests.

Catalina C. Ionita, MD

Assistant Professor of Neurology and Neurosurgery

SUNY

Buffalo

Disclosures

CCI declares that she has no competing interests.

Bernd Hartmann, MD

Chief Physician

Centre for Severe Burns Injuries with Plastic Surgery

Unfallkrankenhaus Berlin (Trauma Hospital Berlin)

Berlin

Germany

Disclosures

BH declares that he has no competing interests.

Differentials
- Cardiac arrest
- Ventricular arrhythmia
- Illicit drug use
More Differentials
Guidelines
- NSW rural adult emergency clinical guidelines, 4.1 ed
- AHA guidelines for CPR and ECC
More Guidelines
Patient leaflets
Burns
More Patient leaflets
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Electrical injury

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

all patients

Contributors

Authors

Baljit Dheansa, MBBS, FRCS, MSc, FRCS (Plast)

Disclosures

Juan Enrique Berner, MD, MSc, MRCS

Disclosures

Acknowledgements

Peer reviewers

Stephen J. Ritz, DO

Disclosures

Catalina C. Ionita, MD

Disclosures

Bernd Hartmann, MD

Disclosures

Differentials

Guidelines

Patient leaflets

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

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