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
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