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  • Even low-voltage electrical injuries can be fatal and often show no external burns.

  • Higher-energy electrical injury can cause massive muscle damage and release of myoglobin. Without adequate early fluid resuscitation, myoglobinuric acute kidney injury can occur.

  • Sufficient fluid should be administered to maintain a urine flow of 1 to 1.5 mL/kg/h, 2 mL/kg/h until the urine is myoglobin-free.

  • Lip and oral commissure burns are initially bloodless and nearly painless, but as the eschar separates in 1 to 2 weeks, severe bleeding can occur as the labial artery is uncovered.

  • Resuscitation of the apparently dead is the rule with lightning injuries.

  • When Thunder Roars, Go Indoors. Every person should learn and teach this preventive action.


Electrical injuries are not common but can be frightening, devastating, and life changing. They may result in massive tissue destruction, changes in growth patterns, and neurologic injury, including chronic pain syndromes, permanent cognitive deficits, and high disability rate, affecting the child’s ability to learn and become a productive adult. Most victims are male. Children at most risk are exploring toddlers (12–30 months). They are more likely to suffer low-voltage injuries because they suck on extension cords or stick things into electrical outlets. Adolescents who often engage in risk-taking behavior may have injuries resulting from contact with utility poles or high-voltage power lines.1–2

The old teaching on electrical injuries involves consideration of voltage, amperage, tissue resistance, current type, duration, and pathway (Kouwenhoven’s factors). Voltage is the difference in electric potential energy between two points and is divided arbitrarily into low and high voltage, with breakpoint at 1000 volts. Amperage is a measure of the rate of flow of electrons and is measured in amperes. Resistance is a measure of the difficulty of electron flow through a given substance. Resistance is measured in ohms.3

The body is composed of different tissues, which express a different resistance to the flow of electrical current. However, the body behaves like a volume conductor.4 Thus body parts exposed to the same current intensity and duration may show different degrees of heat-generated tissue injury. For a given energy, more severe injuries will occur in smaller cross-sectional areas than the same energy flowing through body parts with larger cross-sectional areas such as a thigh or the trunk.5 Damage can be especially high at the joints, where the low-resistance tissues (muscle) are minimized and higher-resistance tissues (tendons, bone, and cartilage) are maximal. Damage to internal organs may be more diffuse and hard to appreciate initially because of the larger cross-sectional diameter of the torso.4,5

When the body is part of an electrical circuit, the skin is the primary resistor to electric current flowing into the body. Resistance is highly variable according to the thickness, age, and moisture,2 which may explain the clinical or forensic findings in electrical ...

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