Electrical Injury – As Explained by Marv from Home Alone

Electricity can flow in a DC (direct current) or AC (alternating current) circuit. DC is a direct flow of electrons, while in AC electrons change direction repeatedly at a certain frequency. All household circuits are AC, while examples of DC currents are the third rail in subways, power lines, or lightning. The reason this matters, if at all, is that AC current is more likely to cause dysrhythmia (i.e. ventricular fibrillation) and tetany resulting in the victim grasping the source and being unable to let go.

High voltage injury is typically defined as anything above 1000V. Household electricity is typically at 120V or 240V, making it low voltage. Injury patterns differ depending on the voltage applied and duration of contact with the electrical source.

At low voltages, patients can still have cardiac dysrhythmias such as ventricular fibrillation. They may have respiratory arrest from chest wall muscle paralysis, and they will likely have superficial burns from any prolonged contact with the electricity if they have sustained tetany. At high voltages, patients are more likely to have asystole and deep thermal burns resulting in muscle, nerve and vascular damage; this, in turn, can lead to rhabdomyolysis and compartment syndrome. Mechanical trauma is also associated with electrical injury due to falls or violent muscle contractions.

Management of high voltage injuries will follow ACLS and ATLS resuscitation guidelines. A thorough physical exam should be performed to evaluate for compartment syndrome, fractures, ruptured tympanic membranes, C-spine injury, and burns. Fluid resuscitation should follow guidelines for crush injuries rather than the Parkland formula.

Low voltage injuries will all require ECG, however testing beyond this will be based on patient’s symptoms. Basic lab testing including CK and UA to evaluate for rhabdomyolysis and myoglobinuria may be considered.

Patients with high voltage injuries should be transferred to a burn center after initial stabilization. Patients with low voltage injuries, no history of loss of consciousness, dysrhythmia, or serious injury requiring admission who also have a normal ECG may be discharged home.

Nah.