Electrical Injuries: Management of Low-Voltage Shocks and Burns in Urgent Care (Trauma CME)

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Delivery Method:	Online
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Publication Date: April 2024 (Volume 3, Number 4)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 04/01/2027.

Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credit, subject to your state and institutional requirements.

Authors

Peer Reviewers

Abstract

Electrical injuries cause approximately 1000 deaths per year in the United States, most often due to either high-voltage electrical injury or lightning strike. However, an additional approximately 30,000 nonfatal shocks occur annually. The type of exposure will guide the management strategy for patients with electrical injury. While most patients with low-risk injuries can be safely managed in and discharged from urgent care, clinicians must be able to recognize high-risk injuries that require transfer to a higher level of care. This review provides evidence-based recommendations for the evaluation and management of electrical injuries in the urgent care setting, including indications for referral to an emergency department or comprehensive burn center.

Case Presentations

A 5-year-old boy is brought to the urgent care clinic by his parents after chewing an electrical cord...

• The cord was connected to a lamp that was plugged into a wall outlet in the family’s home.
• The patient is calm in his mother’s lap. The event occurred 1 hour before arrival, when the parents noticed a ”rash” on the right side of the boy’s lips. They report no other symptoms.
• The patient has stable vital signs. On physical examination, you notice a white and gray eschar to the right oral commissure that is not actively bleeding, with surrounding erythema to the facial skin. There are no intraoral, intranasal, or tongue lesions.
• The parents ask, ”What do we do for the burn, and is his mouth okay?”

A 22-year-old woman presents to the clinic after she “shocked” her left hand on a toaster…

• The event occurred 20 minutes before her arrival at the urgent care clinic. The patient notes that she feels anxious.
• She denies loss of consciousness, lightheadedness, chest pain, heart palpitations, trouble breathing, nausea, abdominal pain, and pain or paresthesia to the affected hand. The patient is left-hand dominant.
• Her vital signs are stable. On physical examination, you note no abnormalities, including entrance or exit wounds or burns to the skin. She is neurovascularly intact to the left hand.
• The patient asks, “Am I okay? I feel funny...”

A 36-year-old man is brought to the clinic by law enforcement after being struck in the left biceps with a TASER device and falling to the ground…

• The event occurred 40 minutes before arrival at the clinic. The patient complains of left wrist pain.
• He denies loss of consciousness, lightheadedness, chest pain, heart palpitations, trouble breathing, nausea, or abdominal pain.
• The patient says he does not believe he has any other injuries or retained barbs in his body. He notes that he is right-hand dominant.
• His vital signs are stable. On physical examination, you note tenderness to the left lateral wrist, with decreased range of motion secondary to pain. He is neurovascularly intact to the right upper extremity.
• After the exam, the patient asks, “Can I just leave now?”

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.