Highlights & Basics
- Electrical injury may be caused by exposure to high- or low-voltage electricity or lightning. Electronic control devices (e.g., Tasers) may also cause a mild electrical injury.
- Recognition of arrhythmias is an essential element of the initial evaluation of electrical injury.
- Most electrical shocks cause no injury.
- May cause electrical and thermal burns, and secondary injuries due to a fall, or severe tetany. Pressure wave injury may occur subsequent to electrical blast.
- Survivors of high-voltage electrical injury or lightning strikes can have long-term sequelae, and regular follow-up is essential.
Quick Reference
History & Exam
Key Factors
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Definition
Epidemiology
Etiology
Pathophysiology
Citations
Spies C, Trohman RG. Narrative review: Electrocution and life-threatening electrical injuries. Ann Intern Med. 2006 Oct 3;145(7):531-7.[Abstract]
Davis C, Engeln A, Johnson E, et al. Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update. Wilderness Environ Med. 2014 Dec;25(4):S86-95.[Abstract][Full Text]
American Heart Association. Part 10.9: electric shock and lightning strikes. Circulation. 2005 Dec 13;112(24):IV-154-5.[Full Text]
Arnoldo B, Klein M, Gibran, NS. Practice guidelines for the management of electrical injuries. J Burn Care Res. 2006 Jul-Aug;27(4):439-47.[Abstract]
1. US National Institute for Occupational Safety and Health. Worker deaths by electrocution: a summary of NIOSH surveillance and investigative findings. May 1998 [internet publication].[Full Text]
2. Spies C, Trohman RG. Narrative review: Electrocution and life-threatening electrical injuries. Ann Intern Med. 2006 Oct 3;145(7):531-7.[Abstract]
3. U.S. Bureau of Labor Statistics. Injuries, illnesses, and fatalities. Dec 2022 [internet publication].[Full Text]
4. National Fire Protection Association. Non fatal electrical injuries at work. May 2022 [internet publication].[Full Text]
5. Centers for Disease Control and Prevention. U.S. Lightning strike deaths. Sep 2022 [internet publication].[Full Text]
6. National Health Service. Hospital accident and emergency activity 2021-22. Sep 2022 [internet publication].[Full Text]
7. Baker MD, Chiaviello C. Household electrical injuries in children. Epidemiology and identification of avoidable hazards. Am J Dis Child. 1989 Jan;143(1):59-62.[Abstract]
8. Böhrer M, Stewart SA, Hurley KF. Epidemiology of electrical and lightning-related injuries among Canadian children and youth, 1997-2010: a Canadian hospitals injury reporting and prevention program (CHIRPP) study. CJEM. 2018 Jul;20(4):586-91.[Abstract][Full Text]
9. Laupland KB, Kortbeek JB, Findlay C, et al. Population-based study of severe trauma due to electrocution in the Calgary Health Region, 1996-2002. Can J Surg. 2005 Aug;48(4):289-92.[Abstract][Full Text]
10. Tirasci Y, Goren S, Subasi M, et al. Electrocution-related mortality: a review of 123 deaths in Diyarbakir, Turkey between 1996 and 2002. Tohoku J Exp Med. 2006 Feb;208(2):141-5.[Abstract][Full Text]
11. Opara KO, Chukwuanukwu TO, Ogbonnaya IS, et al. Pattern of severe electrical injuries in a Nigerian regional burn centre. Niger J Clin Pract. 2006 Dec;9(2):124-7.[Abstract]
12. Maghsoudi H, Adyani Y, Ahmadian N. Electrical and lightning injuries. J Burn Care Res. 2007 Mar-Apr;28(2):255-61.[Abstract]
13. Mohammadi AA, Amini M, Mehrabani D, et al. A survey on 30 months electrical burns in Shiraz University of Medical Sciences Burn Hospital. Burns. 2008;34:111-113.[Abstract]
14. Pasquier M, Carron PN, Vallotton L, et al. Electronic control device exposure: a review of morbidity and mortality. Ann Emerg Med. 2011 Aug;58(2):178-88.[Abstract]
15. Hickey S, Goverman J, Friedstat J, et al. Thermal injuries from exploding electronic cigarettes. Burns. 2018 Aug;44(5):1294-1301.[Abstract][Full Text]
16. Solem L, Fischer RP, Strate RG. The natural history of electrical injury. J Trauma. 1977 Jul;17(7):487-92.[Abstract]
17. Kendrick D, Young B, Mason-Jones AJ, et al. Home safety education and provision of safety equipment for injury prevention. Cochrane Database Syst Rev. 2012 Sep 12;(9):CD005014.[Abstract][Full Text]
18. Zafren K, Durrer B, Herry JP, et al. Lightning injuries: prevention and on-site treatment in mountains and remote areas. Official guidelines of the International Commission for Mountain Emergency Medicine and the Medical Commission of the International Mountaineering and Climbing Federation (ICAR and UIAA MEDCOM). Resuscitation. 2005 Jun;65(3):369-72.[Abstract][Full Text]
19. Davis C, Engeln A, Johnson E, et al. Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update. Wilderness Environ Med. 2014 Dec;25(4):S86-95.[Abstract][Full Text]
20. American Heart Association. Part 10.9: electric shock and lightning strikes. Circulation. 2005 Dec 13;112(24):IV-154-5.[Full Text]
21. Marques EG, Júnior GA, Neto BF, et al. Visceral injury in electrical shock trauma: proposed guideline for the management of abdominal electrocution and literature review. Int J Burns Trauma. 2014 Feb 22;4(1):1-6.[Abstract][Full Text]
22. ten Duis HJ, Klasen HJ, Reenalda PE. Keraunoparalysis, a 'specific' lightning injury. Burns Incl Therm Inj. 1985 Oct;12(1):54-7.[Abstract]
23. Arnoldo B, Klein M, Gibran, NS. Practice guidelines for the management of electrical injuries. J Burn Care Res. 2006 Jul-Aug;27(4):439-47.[Abstract]
24. Lindstrom R, Bylund PO, Eriksson A. Accidental deaths caused by electricity in Sweden, 1975-2000. J Forensic Sci. 2006 Nov;51(6):1383-8.[Abstract]
25. Wijdicks EF, Campeau NG, Miller GM. MR imaging in comatose survivors of cardiac resuscitation. AJNR Am J Neuroradiol. 2001 Sep;22(8):1561-5.[Abstract][Full Text]
26. Shapiro ML, Baldea A, Luchette FA. Rhabdomyolysis in the Intensive Care Unit. J Intensive Care Med. 2012 Nov-Dec;27(6):335-42.[Abstract]
27. Lakkireddy D, Wallick D, Ryschon K, et al. Effects of cocaine intoxication on the threshold for stun gun induction of ventricular fibrillation Am Coll Cardiol. 2006 Aug 15;48(4):805-11.[Abstract]
28. Gallagher CN, Hutchinson PJ, Pickard JD. Neuroimaging in trauma. Curr Opin Neurol. 2007 Aug;20(4):403-9.[Abstract]
29. Olson SA, Glasgow RR. Acute compartment syndrome in lower extremity musculoskeletal trauma. J Am Acad Orthop Surg. 2005 Nov;13(7):436-44.[Abstract]
30. van Ruler R, Eikendal T, Kooij FO, et al. A shocking injury: a clinical review of lightning injuries highlighting pitfalls and a treatment protocol. Injury. 2022 Oct;53(10):3070-7.[Abstract][Full Text]
31. American Heart Association. 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020 Oct 20;142(16_suppl_2):S366-604.[Full Text]
32. Perman SM, Elmer J, Maciel CB, et al. 2023 American Heart Association focused update on adult advanced cardiovascular life support: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2024 Jan 30;149(5):e254-73.[Abstract][Full Text]
33. Ahmed J, Stenkula C, Omar S, et al. Patient outcomes after electrical injury - a retrospective study. Scand J Trauma Resusc Emerg Med. 2021 Aug 6;29(1):114.[Abstract][Full Text]
34. Blackwell N, Hayllar J. A three year prospective audit of 212 presentations to the emergency department after electrical injury with a management protocol. Postgrad Med J. 2002 May;78(919):283-5.[Abstract][Full Text]
35. Froehler MT, Geocadin RG. Hypothermia for neuroprotection after cardiac arrest: Mechanisms, clinical trials and patient care. J Neurol Sci. 2007 Oct 15;261(1-2):118-26.[Abstract]
36. Nolan JP, Sandroni C, Böttiger BW, et al. European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care. Intensive Care Med. 2021 Apr;47(4):369-421.[Abstract][Full Text]
37. Nolan JP, Sandroni C, Böttiger BW, et al. European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care. Resuscitation. 2021 Apr;161:220-69.[Abstract][Full Text]
38. ANZBA. Australian and New Zealand Burn Association. Initial management of severe burns. 2014 [internet publication].[Full Text]
39. Culnan DM, Farner K, Bitz GH, et al. Volume resuscitation in patients with high-voltage electrical injuries. Ann Plast Surg. 2018 Mar;80(3 suppl 2):S113-8.[Abstract]
40. Ministry of Health, NSW. Rural adult emergency clinical guidelines. Apr 2022 [internet publication].[Full Text]
41. Nahab F, Wong She R. Evaluation of updated National Burn Service escharotomy guidelines-where do we cut now? AJOPS. 2023 Mar 29;6(1):1-5. [Full Text]
42. Brown CV, Rhee P, Chan L, et al. Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference? J Trauma. 2004 Jun;56(6):1191-6.[Abstract]
43. Bosch X, Poch E, Grau JM. Rhabdomyolysis and acute kidney injury. N Engl J Med. 2009 Jul 2;361(1):62-72.[Abstract]
44. European Resuscitation Council. Current ERC guidelines. Apr 2021 [internet publication].[Full Text]
45. Arnoldo BD, Purdue GF, Kowalske K, et al. Electrical injuries: a 20-year review. J Burn Care Rehabil. 2004 Nov-Dec;25(6):479-84.[Abstract]
46. Stockly OR, Wolfe AE, Espinoza LF, et al. The impact of electrical injuries on long-term outcomes: A Burn Model System National Database study. Burns. 2020 Mar;46(2):352-9.[Abstract][Full Text]
47. Bailey B, Gaudreault P, Thivierge RL. Cardiac monitoring of high-risk patients after an electrical injury: a prospective multicentre study. Emerg Med J. 2007 May;24(5):348-52 [Erratum in: Emerg Med J. 2007 Aug;24(8):605].[Abstract][Full Text]
48. Quenot JP, Thiery N, Barbar S. When should stress ulcer prophylaxis be used in the ICU? Curr Opin Crit Care. 2009 Apr;15(2):139-43.[Abstract]
49. Barbateskovic M, Marker S, Granholm A, et al. Stress ulcer prophylaxis with proton pump inhibitors or histamin-2 receptor antagonists in adult intensive care patients: a systematic review with meta-analysis and trial sequential analysis. Intensive Care Med. 2019 Feb;45(2):143-58.[Abstract][Full Text]
50. Krag M, Perner A, Wetterslev J, et al. Stress ulcer prophylaxis versus placebo or no prophylaxis in critically ill patients. A systematic review of randomised clinical trials with meta-analysis and trial sequential analysis. Intensive Care Med. 2014 Jan;40(1):11-22.[Abstract][Full Text]
51. Primeau M, Engelstatter GH, Bares KK. Behavioral consequences of lightning and electrical injury. Semin Neurol. 1995 Apr;15(2):279-85.[Abstract][Full Text]
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