Environmental and weapon-related electrical injuries
- Duane S Pinto, MD, MPH
Duane S Pinto, MD, MPH
- Associate Professor of Medicine
- Harvard Medical School
- Peter F Clardy, MD
Peter F Clardy, MD
- Assistant Professor of Medicine
- Harvard Medical School
- Section Editors
- Daniel F Danzl, MD
Daniel F Danzl, MD
- Section Editor — Environmental Emergencies
- Professor of Emergency Medicine
- University of Louisville School of Medicine
- Maria E Moreira, MD
Maria E Moreira, MD
- Section Editor — Adult Trauma
- Associate Professor, Department of Emergency Medicine
- University of Colorado Denver School of Medicine
- Residency Program Director
- Denver Health Residency in Emergency Medicine
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Electrical injuries are relatively common, nearly always accidental, and generally preventable. The direct effect of electrical current, conversion of electrical to thermal energy, and blunt mechanical trauma can result in tissue destruction and organ dysfunction. Appropriate therapy includes management of trauma and a detailed physical assessment. Multiple surgical interventions, including fasciotomy and skin grafting, and prolonged supportive care may be required.
Electrical injuries will be reviewed here. The evaluation and management of burns, general aspects of trauma management, and injuries related to electrosurgery are discussed separately. (See "Emergency care of moderate and severe thermal burns in adults" and "Emergency care of moderate and severe thermal burns in children" and "Initial management of trauma in adults" and "Overview of electrosurgery".)
General — Electrical burns and lightning injuries are estimated to result in more than 3000 admissions to specialized burn units each year in the United States, and account for 3 to 4 percent of all burn-related injuries [1-4]. Up to 40 percent of serious electrical injuries are fatal, resulting in an estimated 1000 deaths per year [4-6].
There is a bimodal distribution of environmental electrical injuries with respect to age. Work-related injuries in adults, and accidents in children, account for most electrical injuries. Incidence is increased among children younger than six years, often because of contact with electric cords or outlets [7,8]; older children generally suffer high-voltage injuries from power lines while climbing trees or utility poles [8,9].
The incidence of electrical injuries decreases through the teenage years and increases again as adults enter the workplace. Together, construction and electrical workers account for about two-thirds of all electrical injuries. Electrical injuries are the second leading cause of occupation-related deaths in the United States. There is an approximately 2:1 male to female ratio in childhood; among adults, more than 90 percent of victims are men [1,5,6,10,11].
- Baxter CR, Waeckerle JF. Emergency treatment of burn injury. Ann Emerg Med 1988; 17:1305.
- Cooper MA. Electrical and lightning injuries. Emerg Med Clin North Am 1984; 2:489.
- Spies C, Trohman RG. Narrative review: Electrocution and life-threatening electrical injuries. Ann Intern Med 2006; 145:531.
- Browne BJ, Gaasch WR. Electrical injuries and lightning. Emerg Med Clin North Am 1992; 10:211.
- Skoog T. Electrical injuries. J Trauma 1970; 10:816.
- Cawley JC, Homce GT. Occupational electrical injuries in the United States, 1992-1998, and recommendations for safety research. J Safety Res 2003; 34:241.
- Baker MD, Chiaviello C. Household electrical injuries in children. Epidemiology and identification of avoidable hazards. Am J Dis Child 1989; 143:59.
- Rabban JT, Blair JA, Rosen CL, et al. Mechanisms of pediatric electrical injury. New implications for product safety and injury prevention. Arch Pediatr Adolesc Med 1997; 151:696.
- Jain S, Bandi V. Electrical and lightning injuries. Crit Care Clin 1999; 15:319.
- Taylor AJ, McGwin G Jr, Davis GG, et al. Occupational electrocutions in Jefferson County, Alabama. Occup Med (Lond) 2002; 52:102.
- Wick R, Gilbert JD, Simpson E, Byard RW. Fatal electrocution in adults--a 30-year study. Med Sci Law 2006; 46:166.
- 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; 65:369.
- Centers for Disease Control and Prevention (CDC). Lightning-associated injuries and deaths among military personnel--United States, 1998-2001. MMWR Morb Mortal Wkly Rep 2002; 51:859.
- O'Keefe Gatewood M, Zane RD. Lightning injuries. Emerg Med Clin North Am 2004; 22:369.
- Lopez, RE, Holle, RL. The underreporting of lightning injuries and death in Colorado. Bull Am Meteor Soc 1995; 74:2171.
- Ritenour AE, Morton MJ, McManus JG, et al. Lightning injury: a review. Burns 2008; 34:585.
- Centers for Disease Control and Prevention (CDC). Lightning-associated deaths--United States, 1980-1995. MMWR Morb Mortal Wkly Rep 1998; 47:391.
- Duclos PJ, Sanderson LM. An epidemiological description of lightning-related deaths in the United States. Int J Epidemiol 1990; 19:673.
- López RE, Holle RL. Demographics of lightning casualties. Semin Neurol 1995; 15:286.
- Bleetman A, Steyn R, Lee C. Introduction of the Taser into British policing. Implications for UK emergency departments: an overview of electronic weaponry. Emerg Med J 2004; 21:136.
- Fish RM, Geddes LA. Effects of stun guns and tasers. Lancet 2001; 358:687.
- Vilke GM, Bozeman WP, Chan TC. Emergency department evaluation after conducted energy weapon use: review of the literature for the clinician. J Emerg Med 2011; 40:598.
- Pasquier M, Carron PN, Vallotton L, Yersin B. Electronic control device exposure: a review of morbidity and mortality. Ann Emerg Med 2011; 58:178.
- Bozeman WP, Teacher E, Winslow JE. Transcardiac conducted electrical weapon (TASER) probe deployments: incidence and outcomes. J Emerg Med 2012; 43:970.
- Gardner AR, Hauda WE 2nd, Bozeman WP. Conducted electrical weapon (TASER) use against minors: a shocking analysis. Pediatr Emerg Care 2012; 28:873.
- Ordog GJ, Wasserberger J, Schlater T, Balasubramanium S. Electronic gun (Taser) injuries. Ann Emerg Med 1987; 16:73.
- Kim PJ, Franklin WH. Ventricular fibrillation after stun-gun discharge. N Engl J Med 2005; 353:958.
- Kornblum RN, Reddy SK. Effects of the Taser in fatalities involving police confrontation. J Forensic Sci 1991; 36:434.
- Mehl LE. Electrical injury from Tasering and miscarriage. Acta Obstet Gynecol Scand 1992; 71:118.
- Dalziel, CF. The threshold of perception currents. Trans Am Inst Electrical Engineering 1954; 73:990.
- Geddes LA, Baker LE. The specific resistance of biological material--a compendium of data for the biomedical engineer and physiologist. Med Biol Eng 1967; 5:271.
- Hawkes, GR. The sensory range of electrical stimulation of the skin. Am J Psychol 1960; 73:485.
- Lee RC, Zhang D, Hannig J. Biophysical injury mechanisms in electrical shock trauma. Annu Rev Biomed Eng 2000; 2:477.
- Cabanes J. Physiologic effects of electric currents on living organisms, more particularly humans. In: Electric Shock Safety Criteria: Proceedings of the First International Symposium on Electric Shock Safety Criteria, Bridges JE, Ford CL, Sherman IA, Valnberg M. (Eds), Pergamon Press, Tarrytown 1985.
- Wright RK, Davis JH. The investigation of electrical deaths: a report of 220 fatalities. J Forensic Sci 1980; 25:514.
- Krider EP, Uman MA. Cloud-to-ground lightning: mechanisms of damage and methods of protection. Semin Neurol 1995; 15:227.
- Lichtenberg R, Dries D, Ward K, et al. Cardiovascular effects of lightning strikes. J Am Coll Cardiol 1993; 21:531.
- Purdue GF, Hunt JL. Electrocardiographic monitoring after electrical injury: necessity or luxury. J Trauma 1986; 26:166.
- Das KM. Electrocardiographic changes following electric shock. Indian J Pediatr 1974; 41:192.
- LOWN B, NEUMAN J, AMARASINGHAM R, BERKOVITS BV. Comparison of alternating current with direct electroshock across the closed chest. Am J Cardiol 1962; 10:223.
- DiVincenti FC, Moncrief JA, Pruitt BA Jr. Electrical injuries: a review of 65 cases. J Trauma 1969; 9:497.
- Wetli CV. Keraunopathology. An analysis of 45 fatalities. Am J Forensic Med Pathol 1996; 17:89.
- Ku CS, Lin SL, Hsu TL, et al. Myocardial damage associated with electrical injury. Am Heart J 1989; 118:621.
- Xenopoulos N, Movahed A, Hudson P, Reeves WC. Myocardial injury in electrocution. Am Heart J 1991; 122:1481.
- McBride JW, Labrosse KR, McCoy HG, et al. Is serum creatine kinase-MB in electrically injured patients predictive of myocardial injury? JAMA 1986; 255:764.
- Kinney TJ. Myocardial infarction following electrical injury. Ann Emerg Med 1982; 11:622.
- Kirchmer JT Jr, Larson DL, Tyson KR. Cardiac rupture following electrical injury. J Trauma 1977; 17:389.
- Ramati A, Pliskin NH, Keedy S, et al. Alteration in functional brain systems after electrical injury. J Neurotrauma 2009; 26:1815.
- Cherington M. Spectrum of neurologic complications of lightning injuries. NeuroRehabilitation 2005; 20:3.
- Davis C, Engeln A, Johnson E, et al. Wilderness medical society practice guidelines for the prevention and treatment of lightning injuries. Wilderness Environ Med 2012; 23:260.
- ten Duis HJ, Klasen HJ, Reenalda PE. Keraunoparalysis, a 'specific' lightning injury. Burns Incl Therm Inj 1985; 12:54.
- Cherington M. Neurologic manifestations of lightning strikes. Neurology 2003; 60:182.
- Caksen H, Yuca SA, Demirtas I, et al. Right thalamic hemorrhage resulting from high-voltage electrical injury: a case report. Brain Dev 2004; 26:134.
- Patten BM. Lightning and electrical injuries. Neurol Clin 1992; 10:1047.
- Gluncić I, Roje Z, Gluncić V, Poljak K. Ear injuries caused by lightning: report of 18 cases. J Laryngol Otol 2001; 115:4.
- Liew L, Morrison GA. Bilateral hearing loss following electrocution. J Laryngol Otol 2006; 120:65.
- ten Duis HJ. Acute electrical burns. Semin Neurol 1995; 15:381.
- Cooper MA. Lightning injuries: prognostic signs for death. Ann Emerg Med 1980; 9:134.
- Vega LA, de Quevedo García JA, Santamariá CT, Porras MC. Clinical picture: An unwanted tattoo. Lancet 2001; 358:1681.
- Moncrief JA, Pruitt BA Jr. Electric injury. Postgrad Med 1970; 48:189.
- Hunt JL, McManus WF, Haney WP, Pruitt BA Jr. Vascular lesions in acute electric injuries. J Trauma 1974; 14:461.
- D'Attellis N, Luong V, Grinda JM. A shocking injury. Lancet 2004; 363:2136.
- Haberal M, Uçar N, Bayraktar U, et al. Visceral injuries, wound infection and sepsis following electrical injuries. Burns 1996; 22:158.
- Rijhwani A, Sunil I. Colonic fistula complicating electric burns--a case report. J Pediatr Surg 2003; 38:1232.
- Schwarz ES, Barra M, Liao MM. Successful resuscitation of a patient in asystole after a TASER injury using a hypothermia protocol. Am J Emerg Med 2009; 27:515.e1.
- Celebi A, Gulel O, Cicekcioglu H, et al. Myocardial infarction after an electric shock: a rare complication. Cardiol J 2009; 16:362.
- Emet M, Caner I, Cakir M, et al. Lightning injury may cause abrupt cerebral salt wasting syndrome. Am J Emerg Med 2010; 28:640.e1.
- Affleck DG, Edelman L, Morris SE, Saffle JR. Assessment of tissue viability in complex extremity injuries: utility of the pyrophosphate nuclear scan. J Trauma 2001; 50:263.
- Sayman HB, Urgancioglu I, Uslu I, Kapicioglu T. Prediction of muscle viability after electrical burn necrosis. Clin Nucl Med 1992; 17:395.
- Hammond J, Ward CG. The use of Technetium-99 pyrophosphate scanning in management of high voltage electrical injuries. Am Surg 1994; 60:886.
- Apfelberg DB, Masters FW, Robinson DW. Pathophysiology and treatment of lightning injuries. J Trauma 1974; 14:453.
- Strasser EJ, Davis RM, Menchey MJ. Lightning injuries. J Trauma 1977; 17:315.
- Yarnell PR, Lammertse DP. Neurorehabilitation of lightning and electrical injuries. Semin Neurol 1995; 15:391.
- Electrical weapons
- PHYSICS OF ELECTRICITY
- MECHANISM OF INJURY
- CLASSIFICATION OF INJURY
- ORGAN INVOLVEMENT
- Vascular, coagulation system, and other injuries
- PHYSICAL EXAMINATION
- Cardiopulmonary resuscitation
- Trauma resuscitation and neurologic evaluation
- Cardiac injury
- Fluid resuscitation
- Skin wounds
- Gastrointestinal injury
- DIAGNOSTIC STUDIES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS