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

Points and Pearls Digest

Points and Pearls Excerpt

  • During evaluation, consider multisystem injuries from thermal reactions, electrical damage, and mechanical trauma.
  • Thermal injury can lead to muscle breakdown, rhabdomyolysis, myonecrosis, edema, compartment syndrome, osteonecrosis, and periosteal burns.
  • Grasping an electrical source can cause tetanic muscle contractions and the inability to “let go,” which will increase the duration of contact and extent of injury.
  • Mechanical injury can result from forceful muscular contractions, and trauma can manifest as fractures and dislocations.
  • Electrical current tends to follow the path of least resistance. Deeper injuries may be found, despite relatively unaffected skin.

Most Important References

  • Glatstein MM, Ayalon I, Miller E, et al. Pediatric electrical burn injuries: experience of a large tertiary care hos-pital and a review of electrical injury. Pediatr Emerg Care. 2013;29(6):737-740. (Retrospective study; 36 patients) DOI: https://doi.org/10.1097/PEC.0b013e318294dd64
  • Arnoldo BD, Purdue GF, Kowalske K, et al. Electrical injuries: a 20-year review. J Burn Care Rehabil. 2004;25(6):479-484. (Retrospective study; 700 patients) https://academic.oup.com/jbcr/article-abstract/25/6/479/4733 820?redirectedFrom=PDF
  • Blackwell N, Hayllar J. A three year prospective audit of 212 presentations to the emergency department after electrical injury with a management protocol. Postgrad Med J. 2002;78(919):283-285. (Prospective study; 212 patients) DOI: http://dx.doi.org/10.1136/pmj.78.919.283
  • Hansen SM, Riahi S, Hjortshøj S, et al. Mortality and risk of cardiac complications among immediate survivors of accidental electric shock: a Danish nationwide cohort study. BMJ Open. 2017;7(8):e015967. (Retrospective study; 11,462 pa-tients) DOI: http://dx.doi.org/10.1136/bmjopen-2017-015967
  • Searle J, Slagman A, Maass W, et al. Cardiac monitoring in patients with electrical injuries. An analysis of 268 patients at the Charité Hospital. Dtsch Arztebl Int. 2013;110(50):847-853. (Retrospective study; 268 patients) https://www.aerzteblatt.de/int/archive/article?id=151368
  • Bailey B, Gaudreault P, Thivierge RL. Neurologic and neuropsychological symptoms during the first year after an electric shock: results of a prospective multicenter study. Am J Emerg Med. 2008;26(4):413-418. (Prospective cohort study; 86 patients) DOI: https://doi.org/10.1016/j.ajem.2007.06.021
  • Avni T, Levcovich A, Ad-El DD, et al. Prophylactic antibiotics for burns patients: systematic review and meta-analysis. BMJ. 2010;340:c241. (Meta-analysis; 17 trials) DOI: https://doi.org/10.1136/bmj.c241
  • Zipes DP. TASER electronic control devices can cause cardiac arrest in humans. Circulation. 2014;129(1):101-111. (Case reports; 8 patients) https://www.ahajournals.org/doi/10.1161/ CIRCULATIONAHA.113.005504
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