Electrical injury is responsible for about 20,000 emergency visits every year in North America, making it one of the most common causes of work-related injuries encountered in clinical practice [1]. Several factors determine the extent of injury, but the most important classification divides electrical injury into those caused by low currents (< 1000 volts, principally seen due to contact with household items) and high-current (> 1000 volts, predominantly in the occupational setting, or lightning strikes) [1] [2] [3] [4]. Paradoxically, injuries caused by low currents are responsible for a more severe clinical presentation, as the electricity travels at a much slower rate through the body compared to high-current injuries, during which the contact with the source is minimal [2] [5]. As the current passes, it damages several tissues in the body, including the skin, the musculoskeletal system, the nervous system, and might interfere with the cardiac pacing activity [1] [2] [6] [7]. Extensive skin burns at the site where the current entered (and exited) the body are the principal manifestation of electrical injury, followed by signs such as pain, paresthesia, weakness, or even muscle tetany, whereas fatigue is a frequent complaint [1] [7]. Compartment syndrome (as a result of venous thrombosis) can also occur and is more frequent in high-voltage injuries [5]. More severe damage to the CNS may cause seizures, quadriplegia, paralysis, coma, and loss of consciousness [5]. Electrical injuries are life-threatening in the presence of cardiac arrhythmia (mainly ventricular fibrillation) or respiratory arrest, and studies estimate that the overall mortality rate is 20-30% [3] [5]. One of the reasons why low currents are more dangerous for humans is its transmission through tissues with lower resistance - blood vessels and the central nervous system [4]. Hence, if patients survive the attack, both short-term and long-term sequelae, primarily neurological (paresthesia, numbness, persistent pain), but also psychological (anxiety, depression, insomnia, flashbacks, nightmares), ophthalmological, and auditory, are more common in low-current vs. high-current injuries [1] [5] [8].

• Unconsciousness

  Unconsciousness in victims of electrical injury may be due to cardiac arrhythmia or respiratory arrest or metabolic alterations. Our patient was unconscious for 24 h and even now amnesic about the event. [nature.com]

  Secure scene; turn off power source for high-voltage incident Assume traumatic injury in unstable or unconscious patient: Spinal immobilization Standard basic life support/advanced ... [5minuteconsult.com]

  CPR should be started if the person is unconscious and you can't feel a pulse. Perform rescue breathing on a person who is unconscious and not breathing or is breathing ineffectually. 6. [medlineplus.gov]

• Reiter Syndrome

  Bony ankylosis has been described following trauma, paralysis, psoriasis, Reiter's syndrome, ankylosing spondylitis, juvenile chronic arthritis and rheumatoid arthritis. Reports of bony ankylosis following thermal and electrical injury are limited. [ncbi.nlm.nih.gov]

• Regurgitation

  A case is presented of segmental ventricular dysfunction and severe aortic regurgitation due to laceration of the right coronary cusp of the aortic valve caused by electrical injury. [ncbi.nlm.nih.gov]

• Tachycardia

  We report on two previously healthy patients who developed severe form of postural orthostatic tachycardia syndrome (POTS) following an electric injury. [ncbi.nlm.nih.gov]

  The risk of malignant dysrhythmias, such as ventricular fibrillation or ventricular tachycardia, is greatest at the time of injury. The incidence of late dysrhythmia is not known but is thought to be very low. [rcemlearning.co.uk]

  Delayed arrhythmia sinus tachycardia and premature ventricular contractions are common in electrical injuries. [hopkinsmedicine.org]

  VF is the usual cause of immediate death from electrocution; this occurs immediately. [ 9 ] Other arrhythmias have been reported: right bundle branch block and nonspecific ST and T-wave changes occur most commonly. [ 6 ] There may be supraventricular tachycardia [patient.info]

• Muscle Weakness

  For the first weeks after injury, pain and muscle weakness dominated. The most frequently occurring symptoms at follow-up were pain, muscle weakness and loss of sensation. [ncbi.nlm.nih.gov]

  In addition, there can be delayed long-term effects such as formation of cataracts, cognitive dysfunction with impairment of short-term memory and emotional lability, and delayed onset of muscle weakness and nerve dysfunction. [ucdenver.edu]

• Ankylosis

  Thirteen cases of burn-related joint ankylosis in four patients are presented. Patients with burns from thermal or electrical injury may develop bony ankylosis among other radiographic manifestations. [ncbi.nlm.nih.gov]

• Frozen Shoulder

  In the present paper, we report 2 cases of low voltage electrical injuries with frozen shoulder development secondary to proximal humerus fracture and supraspinatus tendon tear. [ncbi.nlm.nih.gov]

• Strabismus

  [J Pediatr Ophthalmol Strabismus. 2016;53:e69-e71.]. [ncbi.nlm.nih.gov]

  Ocular complication of lightning .J Pediatr Ophthalmol Strabismus 1975;17:245-6 65. Purdue GF, HuntJL. Electrocardiographic monitoring after electrical injury: necessity or luxury? J Trauma 1986; 26:16~7 66. [lightninginjury.lab.uic.edu]

• Amnesia

  Mutism and dense retrograde amnesia are found both in organic and dissociative contexts. Moreover, dissociative symptoms may be modulated by right prefrontal activity. [ncbi.nlm.nih.gov]

  Results: A 30-year-old lady developed amnesia and spastic paraparesis with loss of pin prick sensation below the second thoracic spinal segment following electrocution. [nature.com]

  Examples include: loss of consciousness, amnesia, confusion, paresthesias, and weakness/paralysis. The limb clumsiness and aphasia affecting our patient fall into this category. [ajnr.org]

  […] early and continued Asystole may spontaneously recover therefore management of apnoea and respiratory arrest is imperative Cardiac: VF likely secondary to hypoxia not lightning shock induced Neurologic: Immediate transient (LOC, confusion, anterograde amnesia [kidshealthwa.com]

• Cerebellar Ataxia

  Electrical injury may result in various acute and delayed neurological complications such as unconsciousness, amnesia, seizure, choreoathetosis, cerebellar ataxia, parkinsonism, myelopathy and peripheral neuropathy. 1 Various structural and functional [nature.com]

• Oscillopsia

  Two weeks later he presented with a sudden onset of headache, unsteadiness, horizontal oscillopsia and paraesthesia in the right side of his face. [ncbi.nlm.nih.gov]

A properly obtained patient history is a pivotal step for identifying the source of signs and symptoms and further clarification of the source (high vs. low current) can be helpful in assessing the risk of complications. A thorough physical examination is equally important, during which physicians must evaluate the musculoskeletal, nervous, and vascular systems through appropriate examination. A complete neurological examination is particularly important, as it may reveal pathological changes long after the initial event [4]. A thorough laboratory and imaging workup is required to evaluate the status of the patient - laboratory studies (a complete blood count, serum electrolytes, urinalysis, creatine kinase levels, cardiac enzymes, etc.) and imaging procedures (plain radiography, ultrasonography, and echocardiography). Electrocardiogram (ECG) should be immediately performed to exclude cardiac arrhythmias, however some authors claim that conscious patients who suffer from minor symptoms after low-current injuries are not at risk for cardiac complications [7]. Furthermore, electrophysiological studies (nerve conduction testing, electromyography, etc.) are recommended for nerve damage [5].

We recommend this flap as the treatment of choice. [ncbi.nlm.nih.gov]

Your doctor or hospital will evaluate the victim and determine whether or not there are injuries that need treatment. [legal-lookout.com]

For patients without prolonged unconsciousness or cardiac arrest, the prognosis for recovery is excellent. People who experience low-voltage injuries with cardiac or respiratory arrest may recover completely with immediate CPR on the scene. [hopkinsmedicine.org]

Prognosis [ 1 ] Mortality : if the initial shock is survived, the chances of survival are excellent. [patient.info]

What Is the Prognosis for Electric Shock? Recovery from electric shock depends on the nature and severity of the injuries. The percentage of the body surface area burned is the most important factor affecting prognosis. [emedicinehealth.com]

This may make it difficult to assess the injury and offer a prognosis based on history and physical examination alone. [lightninginjury.lab.uic.edu]

The specific etiologic factor and pathogenesis of most dilated cardiomyopathies have yet to be described definitively. Hypotheses of the etiologic factor of idiopathic dilated cardiomyopathy (DCM) abound. [ncbi.nlm.nih.gov]

[…] injuries present serious and common form of trauma with a unique etiology, pathophysiology and mechanism of injury. [degruyter.com]

The high frequency of psychological problems is very well established and may be multifactorial in etiology. [cetri.org]

Yet the sparing of the central retinal vessels from significant involvement is somewhat contradictory to the proposed mechanism and a more formal investigation of how electrical current behaves in the eye would be needed to confirm the suggested etiology [djo.harvard.edu]

A discussion of the epidemiology of high-voltage electrical injury in children and the clinical management of electrical-injury-induced cardiac complications is provided. [ncbi.nlm.nih.gov]

Rahman, Epidemiology of electrical injury: Findings from a community based national survey in Bangladesh, Injury, 43, 1, (113), (2012). [doi.org]

Electrical burns in times of economic crisis: A new epidemiologic profile. Elsevier et Masson.2016; 4975: 1-6. [hsd-fmsb.org]

[…] injuries present serious and common form of trauma with a unique etiology, pathophysiology and mechanism of injury. [degruyter.com]

Joule heating and cell membrane disruption are two mechanisms important in understanding the pathophysiology of electrical injury. The degree of tissue damage is often more extensive than initially perceived on clinical exam. [ncbi.nlm.nih.gov]

Prevention of Electrical Burns Three pronged electrical outlets that are grounded are one way to help prevent this type of serious injury. Another good source of prevention is to keep covers on all outlets that are not currently in use. [legal-lookout.com]

They can usually be prevented through simple safety measures. An effective prevention program would help address this problem. [ncbi.nlm.nih.gov]

[…] effects of rhabdomyolysis, may require inotropes/vasopressors if there is significant myocardial dysfunction or SIRS response, Parkland’s formula disability: may have an associated TBI, aim to prevent secondary brain injury, normoglycaemia exposure: [lifeinthefastlane.com]

1. Singerman J, Gomez M, Fish JS. Long-term sequelae of low-voltage electrical injury. J Burn Care Res. 2008;29(5):773-777.
2. Wesner ML, Hickie J. Long-term sequelae of electrical injury. Can Fam Physician. 2013;59(9):935-939.
3. Adukauskiene D, Vizgirdaite V, Mazeikiene S. Electrical injuries [Article in Lithuanian]. Medicina (Kaunas). 2007;43(3):259-266.
4. Kim HM, Ko Y-A, Kim JS, Lim SH, Hong BY. Neurological Complication After Low-Voltage Electric Injury: A Case Report. Ann Rehabil Med. 2014;38(2):277-281.
5. Primavesi R. A shocking episode: Care of electrical injuries. Can Fam Physician. 2009;55(7):707-709.
6. Andrews C. Towards solving enigmas in electrical injury. Crit Care. 2012;16(2):117
7. Bailey B, Gaudreault P, Thivierge RL. Cardiac monitoring of high‐risk patients after an electrical injury: a prospective multicentre study. Emerg Med J. 2007;24(5):348-352.
8. Piotrowski A, Fillet AM, Perez P, et al. Outcome of occupational electrical injuries among French electric company workers: a retrospective report of 311 cases, 1996-2005. Burns. 2014;40(3):480-488.