Decision
Does the patient have any of these criteria?
- Is the patient symptomatic?
- Loss of consciousness
- Abnormal ECG
- Traumatic injuries
- Moderate to severe burns
Background
Patients with low-voltage exposure and no history of loss of consciousness, no cardiac symptoms (eg, palpitations, chest pain), normal or unchanged ECG compared to before the injury, and minor burns can be discharged safely to follow up with a primary care provider. An exception is the child who has bitten an electrical cord, since there is often delayed labial hemorrhage. (See the “Oral Commissure Burns“ section in original article)
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- Consumer Product Safety Commission. National Electronic Injury Surveillance System (NEISS) Estimates Query Builder. Accessed November 15, 2021. (Government database)
- Waldmann V, Narayanan K, Combes N, et al. Electrical injury. BMJ. 2017;357:j1418. (Review article)
- Rotariu EL, Manole MD. Cardiac arrest secondary to lightning strike: case report and review of the literature. Pediatr Emerg Care. 2020;36(1):e18-e20. (Case report)
- American Burn Association. Burn incidence fact sheet: burn incidence and treatment in the United States: 2016. Accessed November 15, 2021. (Data from National Burn Repository)
- Latifi N-A, Karimi H. Acute electrical injury: a systematic review. J Acute Dis. 2017;6(3):93-96. (Systematic review; 51 articles from 1976-2016)
- Zubair M, Besner GE. Pediatric electrical burns: management strategies. Burns. 1997;23(5):413-420. (Retrospective review; 127 patients)
- Garcia CT, Smith GA, Cohen DM, et al. Electrical injuries in a pediatric emergency department. Ann Emerg Med. 1995;26(5):604-608. (Retrospective review; 78 patients)
- Wallace BH, Cone JB, Vanderpool RD, et al. Retrospective evaluation of admission criteria for paediatric electrical injuries. Burns. 1995;21(8):590-593. (Retrospective review; 35 patients)
- 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;20(4):586-591. (Retrospective review; 1183 injuries) DOI: 10.1017/cem.2017.49
- Depamphilis MA, Cauley RP, Sadeq F, et al. Surgical management and epidemiological trends of pediatric electrical burns. Burns. 2020;46(7):1693-1699. (Retrospective review; 68 patients)
- Arasli Yilmaz A, Köksal AO, Özdemir O, et al. Evaluation of children presenting to the emergency room after electrical injury. Turk J Med Sci. 2015;45(2):325-328. (Retrospective review; 36 patients)
- D’Souza AL, Nelson NG, McKenzie LB. Pediatric burn injuries treated in US emergency departments between 1990 and 2006. Pediatrics. 2009;124(5):1424-1430. (Retrospective review; 62,196 patients)
- 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(7):696-700. (Case series; 144 patients)
- Demir S, Demir TO, Erturk A, et al. Electrical injuries in children: a 10-year experience at a tertiary pediatric burn center. J Burn Care Res. 2021;42(4):801-809. (Retrospective review; 1463 patients)
- Celik A, Ergün O, Ozok G. Pediatric electrical injuries: a review of 38 consecutive patients. J Pediatr Surg. 2004;39(8):1233-1237. (Retrospective review; 38 patients)
- Glatstein MM, Ayalon I, Miller E, et al. Pediatric electrical burn injuries: experience of a large tertiary care hospital and a review of electrical injury. Pediatr Emerg Care.2013;29(6):737-740. (Retrospective review; 36 patients)
- Lee RC, Zhang D, Hannig J. Biophysical injury mechanisms in electrical shock trauma. Annu Rev Biomed Eng. 2000;2:477-509. (Review article)
- Koutroulis I, Agrawal D. Environmental Emergencies, Radiological Emergencies, Bites and Stings. In: Shaw KN, Bachur RG, eds. Fleisher & Ludwig’s Textbook of Pediatric Emergency Medicine. 8th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2021:696-699. (Textbook chapter)
- Arnoldo B, Klein M, Gibran NS. Practice guidelines for the management of electrical injuries. J Burn Care Res. 2006;27(4):439-447. (Practice guidelines)
- Allorto N, Atieh B, Bolgiani A, et al. ISBI practice guidelines for burn care, part 2. Burns. 2018;44(7):1617-1706. (Practice guidelines) DOI: 10.1016/j.burns.2018.09.012
- ISBI Practice Guidelines Committee, Steering Subcommittee, Advisory Subcommittee. ISBI practice guidelines for burn care. Burns. 2016;42(5):953-1021. (Practice guidelines)
- Koumbourlis AC. Electrical injuries. Crit Care Med. 2002;30(11 Suppl):S424-S430. (Review article)
- Fish R. Electric shock, part I: physics and pathophysiology. J Emerg Med. 1993;11(3):309-312. (Review article)
- Arnoldo BD, Purdue GF, Kowalske K, et al. Electrical injuries: a 20-year review. J Burn Care Rehabil. 2004;25(6):479-484. (Retrospective review; 700 patients) DOI: 10.1097/01.bcr.0000144536.22284.5c
- Khan F, Tupe C. Electrical and lightning injuries. Trauma Reports. 2016;17(2):1-11. (Review article)
- Arnoldo BD, Purdue GF. The diagnosis and management of electrical injuries. Hand Clin.2009;25(4):469-479. (Review article)
- Sanford A, Gamelli RL. Lightning and thermal injuries. Handb Clin Neurol. 2014;120:981-986. (Review article)
- Price TG, Cooper MA. Electrical and lightning injuries. In: Marx JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 8th ed.Philadelphia: Elsevier Saunders; 2014:1906-1914. (Textbook chapter)
- Lee DH, Desai MJ, Gauger EM. Electrical injuries of the hand and upper extremity. J Am Acad Orthop Surg. 2019;27(1):e1-e8. (Review article)
- Walker A, Salerno A. Shocking injuries: knowing the risks and management for electrical injuries. Trauma Reports. 2019;20(4):1-12. (Review article)
- Zemaitis MR, Foris LA, Lopez RA, et al. Electrical Injuries. StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. (Review article)
- Roberts S, Meltzer JA. An evidence-based approach to electrical injuries in children. Pediatr Emerg Med Pract. 2013;10(9):1-20. (Review article)
- O’Keefe Gatewood M, Zane RD. Lightning injuries. Emerg Med Clin North Am.2004;22(2):369-403. (Review article)
- Ciorciari AJ, Chamdawala H, Chou KJ. Environmental emergencies. In: Gershel JC, Crain EF, eds. Clinical Manual of Emergency Pediatrics. Cambridge: Cambridge University Press; 2018:207-233. (Textbook chapter)
- Chen EH, Sareen A. Do children require ECG evaluation and inpatient telemetry after household electrical exposures? Ann Emerg Med. 2007;49(1):64-67. (Systematic review; 7 articles from 1966-2007) DOI: 10.1016/j.annemergmed.2006.05.004
- Waldmann V, Narayanan K, Combes N, et al. Electrical cardiac injuries: current concepts and management. Eur Heart J. 2018;39(16):1459-1465. (Review article)
- Spies C, Trohman RG. Narrative review: electrocution and life-threatening electrical injuries. Ann Intern Med. 2006;145(7):531-537. (Review article)
- Hansen SM, Riahi S, Hjortshøj S, et al. Mortality and risk of cardiac complications among immediate survivors of accidental electric shock: a Danish nationwide cohort study. BMJ Open. 2017;7(8):e015967. (Retrospective study; 11,462 patients) DOI: 10.1136/bmjopen-2017-015967
- Searle J, Slagman A, Maaß W, et al. Cardiac monitoring in patients with electrical injuries. An analysis of 268 patients at the Charité Hospital. Dtsch Arztebl Int.2013;110(50):847-853. (Retrospective; 268 patients) DOI: 10.3238/arztebl.2013.0847
- McLeod JS, Maringo AE, Doyle PJ, et al. Analysis of electrocardiograms associated with pediatric electrical burns. J Burn Care Res. 2018;39(1):65-72. (Retrospective review; 86 patients) DOI: 10.1097/bcr.0000000000000591
- Arrowsmith J, Usgaocar RP, Dickson WA. Electrical injury and the frequency of cardiac complications. Burns. 1997;23(7-8):576-578. (Retrospective review; 145 patients)
- American Burn Association, ABLS Advisory Committee. Advanced Burn Life Support Course Providers Manual. Chicago: American Burn Association; 2018. (Manual)
- Alemayehu H, Tarkowski A, Dehmer JJ, et al. Management of electrical and chemical burns in children. J Surg Res. 2014;190(1):210-213. (Retrospective review; 50 patients)
- Gokdemir MT, Kaya H, Söğüt O, et al. Factors affecting the clinical outcome of low-voltage electrical injuries in children. Pediatr Emerg Care. 2013;29(3):357-359. (Cross-sectional study; 36 patients)
- Rai J, Jeschke MG, Barrow RE, et al. Electrical injuries: a 30-year review. J Trauma.1999;46(5):933-936. (Retrospective review; 185 patients)
- Tapking C, Hundeshagen G, Popp D, et al. The frequency and reason for amputations in electrically burned pediatric patients. J Burn Care Res. 2019;40(1):107-111. (Retrospective review; 299 patients)
- Chavez LO, Leon M, Einav S, et al. Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice. Crit Care. 2016;20(1):135. (Systematic review; 23 articles from 2006-2015)
- Boyd AN, Hartman BC, Sood R, et al. A voltage-based analysis of fluid delivery and outcomes in burn patients with electrical injuries over a 6-year period. Burns. 2019;45(4):869-875. (Retrospective review; 36 patients)
- Pradhan E, Khatri A, Ahmed AA, et al. Lightning injury to eye: brief review of the literature and case series. Clin Ophthalmol. 2020;14:597-607. (Case series; 7 patients)
- Modayil PC, Lloyd GW, Mallik A, et al. Inner ear damage following electric current and lightning injury: a literature review. Eur Arch Otorhinolaryngol. 2014;271(5):855-861. (Meta-analysis; 35 articles)
- Gluncić I, Roje Z, Gluncić V, et al. Ear injuries caused by lightning: report of 18 cases. J Laryngol Otol. 2001;115(1):4-8. (Retrospective review; 18 patients)
- Toon MH, Maybauer DM, Arceneaux LL, et al. Children with burn injuries--assessment of trauma, neglect, violence and abuse. J Inj Violence Res. 2011;3(2):98-110. (Review article)
- Shrivastava P, Goel A. Pre-hospital care in burn injury. Indian J Plast Surg.2010;43(Suppl):S15-S22. (Review article)
- Topjian AA, Raymond TT, Atkins D, et al. Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142(16_suppl_2):S469-S523. (Guidelines)
- Davis C, Engeln A, Johnson EL, et al. Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update. Wilderness Environ Med. 2014;25(4 Suppl):S86-S95. (Practice guidelines)
- Strobel AM, Fey R. Emergency care of pediatric burns. Emerg Med Clin North Am.2018;36(2):441-458. (Review article)
- Fish RM. Electric injury, Part I: treatment priorities, subtle diagnostic factors, and burns. J Emerg Med. 1999;17(6):977-983. (Review article)
- Pinto DS, Clardy PF. Environmental and weapon-related electrical injuries. Accessed November 15, 2021. (Review article)
- Bailey B, Gaudreault P, Thivierge RL, et al. Cardiac monitoring of children with household electrical injuries. Ann Emerg Med. 1995;25(5):612-617. (Retrospective review; 141 patients) DOI: 10.1016/s0196-0644(95)70173-7
- Haim A, Zucker N, Levitas A, et al. Cardiac manifestations following electrocution in children. Cardiol Young. 2008;18(5):458-460. (Retrospective review; 52 patients)
- American College of Surgeons Committee on Trauma. ATLS Advanced Trauma Life Support: Student Course Manual. 10th ed. Chicago: American College of Surgeons; 2018. (Manual)
- Ellison A, Samuels-Kalow ME. Burns. In: Shaw KN, Bachur RG, eds. Fleisher & Ludwig's Textbook of Pediatric Emergency Medicine. Philadelphia: Lippincott Williams & Wilkins; 2021:1095-1103. (Textbook chapter)
- Joffe MD. Moderate and severe thermal burns in children: emergency management. Accessed January 15, 2021. (Review article)
- Scharman EJ, Troutman WG. Prevention of kidney injury following rhabdomyolysis: a systematic review. Ann Pharmacother. 2013;47(1):90-105. (Systematic review; 27 studies)
- Ghavami Y, Mobayen MR, Vaghardoost R. Electrical burn injury: a five-year survey of 682 patients. Trauma Mon. 2014;19(4):e18748. (Retrospective review; 682 patients)
- Martin-Herz SP, Patterson DR, Honari S, et al. Pediatric pain control practices of North American burn centers. J Burn Care Rehabil. 2003;24(1):26-36. (Prospective survey; 82 centers with 111 surveys)
- Cherington M. Neurologic manifestations of lightning strikes. Neurology. 2003;60(2):182-185. (Review article)
- Cherington M. Spectrum of neurologic complications of lightning injuries. NeuroRehabilitation. 2005;20(1):3-8. (Review article)
- ten Duis HJ, Klasen HJ, Reenalda PE. Keraunoparalysis, a ‘specific’ lightning injury. Burns Incl Therm Inj. 1985;12(1):54-57. (Case series; 2 patients)
- Ritenour AE, Morton MJ, McManus JG, et al. Lightning injury: a review. Burns. 2008;34(5):585-594. (Review article)
- Byard RW, Thu M, Gilbert JD. Cutaneous manifestations of lightning strike - variability in Lichtenberg figures. Forensic Sci Med Pathol. 2017;13(3):390-393. (Case series; 2 patients)
- Bartholome CW, Jacoby WD, Ramchand SC. Cutaneous manifestations of lightning injury. Arch Dermatol. 1975;111(11):1466-1468. (Case report)
- Umstattd LA, Chang CW. Pediatric oral electrical burns: incidence of emergency department visits in the United States, 1997-2012. Otolaryngol Head Neck Surg.2016;155(1):94-98. (Retrospective review; 1042 patients)
- Pontini A, Reho F, Giatsidis G, et al. Multidisciplinary care in severe pediatric electrical oral burn. Burns. 2015;41(3):e41-e46. (Case report)
- Garritano FG, Carr MM. Oral commissure burns in children. Oper Tech Otolaryngol Head Neck Surg 2015;26(3):136-142. (Review article)
- Milano M. Oral electrical and thermal burns in children: review and report of case. ASDC J Dent Child. 1999;66(2):116-119. (Case report)
- Yeroshalmi F, Sidoti EJ Jr, Adamo AK, et al. Oral electrical burns in children-a model of multidisciplinary care. J Burn Care Res. 2011;32(2):e25-30. (Case report)
- Ginwalla M, Battula S, Dunn J, et al. Termination of electrocution-induced ventricular fibrillation by an implantable cardioverter defibrillator. Pacing Clin Electrophysiol. 2010;33(4):510-512. (Case report)
- Kondur AK, Afonso LC, Berenbom LD, et al. Implantable cardioverter defibrillators save lives from lightning-related electrocution too! Pacing Clin Electrophysiol. 2008;31(2):256-257. (Case report)
- Fatovich DM. Electric shock in pregnancy. J Emerg Med. 1993;11(2):175-177. (Case series; 15 patients)
- Sparić R, Malvasi A, Nejković L, et al. Electric shock in pregnancy: a review. J Matern Fetal Neonatal Med. 2016;29(2):317-323. (Review article)
- Fish RM. Electric injury, part III: cardiac monitoring indications, the pregnant patient, and lightning. J Emerg Med. 2000;18(2):181-187. (Review article)
- El Sayed M, El Tawil C, Tamim H, et al. Emergency medical services experience with barb removal after TASER use by law enforcement: a descriptive national study. Prehosp Disaster Med. 2019;34(1):38-45. (Retrospective review; 648 patients)
- Bozeman WP, Teacher E, Winslow JE. Transcardiac conducted electrical weapon (TASER) probe deployments: incidence and outcomes. J Emerg Med. 2012;43(6):970-975. (Retrospective review; 1201 patients)
- Gardner AR, Hauda WE 2nd, Bozeman WP. Conducted electrical weapon (TASER) use against minors: a shocking analysis. Pediatr Emerg Care. 2012;28(9):873-877. (Retrospective review; 2026 subjects)
- Bozeman WP, Hauda WE 2nd, Heck JJ, et al. Safety and injury profile of conducted electrical weapons used by law enforcement officers against criminal suspects. Ann Emerg Med. 2009;53(4):480-489. (Prospective multicenter observational study; 1201 patients)
- Vilke G, Chan T, Bozeman WP, et al. Emergency department evaluation after conducted energy weapon use: review of the literature for the clinician. J Emerg Med.2019;57(5):740-746. (Systematic review; 37 articles from 1988-2018)
- 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(2):136-140. (Review article)
- Ramos G, Cornistein W, Cerino GT, et al. Systemic antimicrobial prophylaxis in burn patients: systematic review. J Hosp Infect. 2017;97(2):105-114. (Systematic review; 19 articles from 1966-2016)
- Barajas-Nava LA, López-Alcalde J, Roqué i Figuls M, et al. Antibiotic prophylaxis for preventing burn wound infection. Cochrane Database Syst Rev. 2013(6):CD008738. (Cochrane review; 36 randomized controlled trials, 2117 participants) DOI: 10.1002/14651858.CD008738.pub2
- Andrews CJ, Panescu D. Protocols for documentation of electrical injuries for electrical safety inspectors and emergency medical practitioners. J Trauma Acute Care Surg.2019;87(2):483-490. (Guidelines)
- Purdue GF, Hunt JL. Electrocardiographic monitoring after electrical injury: necessity or luxury. J Trauma. 1986;26(2):166-167. (Retrospective review; 48 patients)
- Bailey B, Gaudreault P, Thivierge RL. Experience with guidelines for cardiac monitoring after electrical injury in children. Am J Emerg Med. 2000;18(6):671-675. (Retrospective review; 224 patients)
- 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. (Multicenter prospective observational study; 134 patients)
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