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 

Disposition

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

References:

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