Practice Clinical updates

Electrical injury

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1418 (Published 12 April 2017) Cite this as: BMJ 2017;357:j1418
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Infographic available

Click here for a visual overview of assessment for people with electrical injuries, including when to admit, and when people at low risk of complications can safely be discharged.

  1. Victor Waldmann, research fellow in cardiology1 2 3,
  2. Kumar Narayanan, consultant cardiologist, senior research associate3 4,
  3. Nicolas Combes, consultant cardiologist5,
  4. Eloi Marijon, cardiologist, associate professor of medicine1 2 3
  1. 1Cardiology Department, European Georges Pompidou Hospital, 20-40 rue Leblanc, 75908 Paris Cedex 15, France
  2. 2Paris Descartes University, Paris, France
  3. 3Paris Cardiovascular Research Center, Paris, France
  4. 4Cardiology Department, Maxcure Hospitals, Hyderabad, India
  5. 5Cardiology Department, Clinique Pasteur, Toulouse, France
  1. Correspondence to: E Marijon eloi_marijon{at}yahoo.fr

What you need to know

  • Electrical injuries are relatively uncommon but can be life threatening, causing extensive burns or internal organ damage

  • Wet skin can make otherwise be a minor injury more serious

  • Arrhythmias are the most common cardiac complication and may sometimes present late

  • Non-specific electrocardiographic (ECG) changes may be the only indicator of cardiac damage

  • Patients who have a normal ECG on admission after a low voltage injury with no loss of consciousness or initial cardiac arrest may be discharged home

Electrical injuries can range from small skin burns to life threatening internal organ damage. The most extreme form of electric shock, such as caused by a lightning strike, often results in instant death by electrocution. There is a lack of evidence regarding the management of patients after electrical accidents, which can cause concern for clinicians when these patients present.

This article discusses the main types of electrical injuries, their underlying pathophysiology, and practical issues relating to monitoring and treating seriously injured patients as well as those who are apparently well.

How common are electric shocks?

Many electrical accidents go unreported, so the true incidence is difficult to estimate. In the United States, the American Burn Association (www.ameriburn.org) estimates 4400 people are injured in electrical accidents and 400 others die from electrocutions each year, which are mostly work related (miners, electricians, and construction workers). Lightning strikes are responsible for up to 100 deaths a year.123

Of those admitted to US specialist burn units annually, 3-6% have had an electric shock.4 Many of the victims are young adults or adolescents, whose injuries often result from outdoor adventurous activities (such as climbing an electric pole, exploration of dangerous place as railway stations) and children involved in household accidents, mostly due to oral contact with electrical cords or …

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