Electricity generates heat through tissue resistance or directly by the current on cells. Many factors affect injury severity: type of current (DC or AC), intensity, duration, tissue resistance, and pathway through the body. When electricity traverses the tissues, it may cause contact burns, thermal injury, muscular tetany, or severe contraction. Sudden death (asystole, respiratory arrest, ventricular fibrillation), myocardial damage, myoglobinuria, compartment syndrome, and various metabolic disorders have been described.
Electrical Burn. This patient grabbed a high-voltage power line with his hand. Exit wounds occurred where the patient was grounded, through his feet. This patient with transthoracic injury should have cardiac monitoring. (Photo contributor: Alan B. Storrow, MD.)
High-voltage DC or AC current typically causes a single violent muscular contraction and throws the victim from the source; blunt trauma and blast injuries may occur. Low-voltage AC currents (as from a household outlet) may cause muscular tetany, forcing the victim to continue contact with the source.
Electrical Flashover Burn. A patient struck by flashover electricity while repairing urban outdoor electric lines. (Photo contributor: Selim Suner, MD, MS.)
Management and Disposition
After initial stabilization, consider cervical spine immobilization, oxygen administration, cardiac monitoring, and IV crystalloid infusion. A Foley catheter will help monitor urine output and is especially important if rhabdomyolysis is suspected. Diagnostic testing to consider includes ECG, complete blood count, urinalysis, creatine phosphokinase (CPK), CPK-MB, electrolytes, blood urea nitrogen, creatinine, and coagulation profile.
Severe or high-risk injuries should be admitted to a burn unit or a trauma center with burn consultation. Patients with minor, brief, low-intensity exposures; a normal ECG; normal urinalysis; and no significant burns or trauma may be considered for discharge after a period of observation.
Electrical Burn. Extensive electrical hand burn from a high-voltage power line. (Photo contributor: David Effron, MD.)
Toddlers are at increased risk of labial injury from chewing on electrical cords.
High-risk features include high-voltage exposure (>600 V), deep burns, neurologic injury, dysrhythmias, abnormal ECG, evidence of rhabdomyolysis, suicidal intent, or significant associated trauma.
DC Thermal Ring Injury. This middle-aged man sustained a circumferential thermal finger burn. His ring was heated when a wrench he was holding simultaneously contacted both terminals on a car battery. (Photo contributor: Aubrey Mowery, MSN, MPH, CPNP.)