Pediatric emergency medicine trisk 1961 1961
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Children who have sustained minor household electrical injuries and
are asymptomatic usually do not require laboratory evaluation, cardiac
evaluation, or hospitalization.
In more severe injuries, entry and exit wounds and arc burns are poor
predictors of internal damage. Tissue that appears viable initially may
become ischemic over several days.
Current Evidence
An electrical injury occurs when a person comes into contact with the current
produced by a human-made or natural source. The spectrum of electrical injury is
enormous, ranging from low-voltage household accidents to million-volt
lightning strikes ( Table 90.8 ). Appropriate management requires an
understanding of the basic physical aspects of electricity, the physiologic
responses to injury, and the potential for immediate and delayed damage.
Lightning that strikes individuals carries a 30% risk of mortality and claims
approximately 100 lives annually in the United States. The death rate is highest
among children ranging from 15 to 19 years of age. The majority of struck-bylightning injuries in the United States originate in the South and the Midwest.
Harnessed electrical power is responsible for approximately 700 deaths/year, of
which 10% are children. Household electrical cords are the major cause of
electrocution in children 12 years of age and younger, with an estimated 1,000
ED visits for oral electrical burns from 1997 to 2012. High-tension electrical
injuries dominate in older children who climb on trees, buildings, or utility
structures. Tasers and stun guns, which are high-voltage, low-current stimulators,
cause pain due to involuntary muscle contractions.
The severity of electrical injury depends on six factors: (i) The resistance of
skin, mucosa, and internal structures; (ii) the type of current (alternating or
direct); (iii) the frequency of the current; (iv) the intensity; (v) the duration of
contact; and (vi) the pathway taken by the current. Precise separation of the effect
of these factors, which are interrelated, is impossible. Together, they produce
either heat or current, and a variety of injuries result.
