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
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].
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- 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