#EMConf: Electrical Injuries

Basic Principles:

  • Low resistance, High current: nerves, wet skin
  • Electricity is converted to thermal energy 
  • High Voltage is > 1000 V
    • Can lead to asystole
    • Can cause significant damage of organs & tissues
    • "Tip of the Iceberg": May be more severely injured than they appear 

Alternating Current (AC): 

  • Causes tetany thus sustained contraction thus longer exposure to source 
  • Low Voltage AC: V-Fib
  • HIgh Voltage AC: Asystole

Direct Current (DC): Batteries, electric cars, etc. 

  • Single contraction: traumatic injuries, dislocations 
  • Causes asystole 

Electrocution Injuries:

  • CNS: Transient loss of conciousness with central apnea; spinal cord syndomes (can be delayed); paresthesias 
  • Cardiac: Cardiac Arrest, Dysrhythmias
  • MSK: Posterior Shoulder Dislocation, Fractures, Rhabdomyolysis, Compartment Syndrome
  • Pulmonary: Respiratory Arrest with prolonged apnea 
  • Ocular: cataracts can present later 
  • Cutaneous: extent of skin damage not predictive of internal damage 


    • Admit: Dysrhtyhmia or Ischemia or EKG changes
    • Discharge: Low voltage injury, minor burns/ symptoms, normal UA, normal EKG 


Price T,Cooper M.“Electrical and Lightning Injuries.”In: Rosen's Emergency MedicineConcepts and Clinical Practice.7th ed.Philadelphia, PA:Elsevier; 2010: 1893-1902.BaileyC. “Electrical and Lightning Injury” In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, MecklerGD, Cline DM. eds.Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8eNewYork, NY: McGraw-Hill; 2016