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KEY POINTS

KEY POINTS

  • All patients are to be considered to have multisystem injuries, including cervical spine fracture, until such injuries are ruled out.

  • Intravenous fluid resuscitation should not be underestimated. The preservation of renal function depends largely on adequate volume resuscitation.

  • Most patients should be monitored for cardiac dysrhythmias for 24 to 48 hours after injury, particularly if electrocardiographic abnormalities were present or persist.

  • Early recognition and decompression of compartment syndromes are critical for maximizing extremity salvage and long-term function.

  • Adequate wound care necessitates complete debridement of nonviable tissue followed by wound closure as expeditiously as possible.

  • Survivors of electrical injury often experience chronic neuromuscular sequelae that can impact rehabilitation and the ability to return to work.

INTRODUCTION

In the United States, over 7000 cases of electrical injuries were reported from 2009 to 2018, occurring most commonly in males between 20 and 50 years old.1 Electric shock is one of the leading causes of work-related injury, comprising 8.5% of all workplace fatalities,2 and the majority of these deaths occurred while engaging in constructing, repairing, or cleaning activities.3 Immediate death can result from cardiac dysrhythmia, central respiratory arrest, or asphyxia due to tetanic contraction of the muscles of respiration. If the patient survives the initial cardiopulmonary or central nervous system (CNS) insult, they then may face potential limb- and life-threatening sequelae from cutaneous injury, internal tissue destruction, compartment syndrome, and organ system dysfunction, requiring multidisciplinary intensive care at a specialized burn center. The distribution of the tissues and organs damaged depends on the path of the injury current. Frequently, the injury is complicated by associated blunt trauma when the patient either falls from a height or is thrown by the force of the electric current.

At less than 1000 volts (V), direct contact is usually required for electrical conduction. For higher voltages (>1000 V), arcing usually initiates the electrical contact. Most electrical injuries are due to low-voltage (<1000 V) electrical shock. Whereas low-voltage shocks carry a significant risk of electrocution-induced cardiac arrest, high-voltage shock injury is characterized by extensive tissue damage, rather than electrocution. For the years 2009 to 2018, 3.6% of all burn unit admissions in the United States were for electrical injuries, many a result of high-voltage (>1000 V) shocks.1

The duration of contact with the high-voltage power source and the distribution of electrical current are important factors in the magnitude of the injury. If the contact is brief (ie, less than 0.5 seconds), cell damage can occur through nonthermal component of electrical injury, called electroporation.4 If the contact is longer, both heating caused by electrical conduction (joule heating) and electroporation play important roles. Prolonged contact can lead to thermal burning of tissues in the current’s path. The electrical current distribution across the tissues between the surface contact points depends on the electrical conductivity of the various tissues and on the ...

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