Pediatric Electrical Injuries in the Emergency Department: An Evidence-Based Review (Trauma CME) -

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Publication Date: December 2021 (Volume 18, Number 12)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 12/01/2024.

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

Authors

Peer Reviewers

Abstract

Electrical injuries in pediatric patients are uncommon but can be life-threatening and require efficient and effective identification and management. Injury severity is based on the characteristics of the electricity, the duration of contact with the electrical source, and the current’s pathway through the body. This issue discusses the specific threats posed by high-voltage, low-voltage, and lightning injuries. The various presentations are described, including burns, arrhythmias, respiratory arrest, cardiac arrest, blunt trauma from falls or blast events, rhabdomyolysis, tympanic membrane rupture, and altered mental status, among others. The most current literature is reviewed, and an evidence-based approach is provided for the diagnosis and management of electrical injuries in pediatric patients presenting to the emergency department.

Case Presentations

A 13-year-old girl who was struck by lightning while playing soccer is brought in by EMS…

• The girl was playing soccer in an open field when a thunderstorm started. While trying to take shelter, lightning struck a tree approximately 2 feet away, and she was thrown several feet. An adult observed that she was unresponsive, so he called 911 and initiated CPR. When EMS arrived, an AED was placed and a shock was delivered, with subsequent return of spontaneous circulation. The patient was prepped for transport with a C-collar in place. During transport, her cardiac rhythm was sinus tachycardia, with a palpable pulse, and bag-valve mask ventilation was initiated for no spontaneous respirations.
• Upon arrival to the ED, the girl is unresponsive. She has an intact airway but no spontaneous respirations. She has symmetric, clear breath sounds with bag-valve mask ventilation. Cardiac rhythm is sinus tachycardia with a palpable pulse, and her blood pressure is 130/90 mm Hg. She has a GCS score of 3. Her pupils are 4- to 5-mm and nonreactive. She has a Lichtenberg figure across her rib cage, an erythematous irregular patch on the dorsum of her right foot, and there is bloody drainage from her left ear.
• How should you evaluate and manage this patient in the ED?

An 18-month-old boy is brought in by his parents after he was found chewing on an electric cord...

• The boy is well appearing, with age-appropriate vital signs. He is noted to have grayish-white tissue on the right oral commissure, without bleeding. His dentition and tongue are intact, he has no trouble handling his secretions, and he is able to drink without problem.
• What complication of this injury should you consider? What is the appropriate disposition for this patient? How should you advise the parents?

A 3-year-old girl is brought into the ED by her father after she was found crying and sitting by a kitchen electrical outlet with a fork next to her…

• The girl is well appearing, with age-appropriate vital signs. She is playing quietly with her father.
• On examination, no external injuries are noted.
• What workup and monitoring are required in the ED? What should this patient’s disposition be? What education should you give her father?