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Electrical injuries occur with a wide spectrum of damage, from superficial skin burns to multisystem injury. Electrical injuries are arbitrarily classified as those of low voltage (≤1000 V) and high voltage (>1000 V).

Clinical Features

Electricity-induced injuries can occur via several mechanisms: (1) direct tissue damage from the electrical energy, (2) tissue damage from thermal energy, and (3) mechanical injury from trauma induced by a fall or muscle contraction. Patients may sustain immediate cardiac dysrthymias including ventricular fibrillation, respiratory arrest, or seizures. Cardiac complications are more commonly seen in high-voltage injuries. Temporary loss of consciousness is common. Severe burns may result from contact with high-voltage lines. The size of the skin injury does not correlate well with internal injuries. Traumatic injuries frequently accompany electrical injuries. The details of specific immediate and delayed systemic injuries and complications are summarized in Table 126-1.

Table 126-1

Immediate and Delayed Complications of Electrical Injuries

Diagnosis and Differential

The diagnosis of electrical injury is usually based on the history of contact with an electrical source and the typical skin or oral lesions in children. However, patients with amnesia or any other type of altered mental status, with no skin injuries, must undergo an interview and a more detailed physical examination, especially for possible thunderstorm incidents. Laboratory and radiographic evaluation of high-voltage injures should follow standard trauma guidelines. Atrial or ventricular arrhythmias, bradyarrthymias, prolonged QT intervals or ST-T wave abnormalities may be noted on the ECG. An elevated serum CK, myoglobin or urine myoglobin suggests ...

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