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].

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].

Treatment of electrical injuries is tailored to the severity and type of injury. Initial management focuses on stabilizing the patient, ensuring airway, breathing, and circulation are maintained. Burns are treated with appropriate wound care, and pain management is provided. In cases of cardiac or respiratory arrest, resuscitation efforts are critical. Long-term care may involve rehabilitation for neurological or muscular damage.

The prognosis for electrical injury varies. Minor injuries may heal with minimal intervention, while severe injuries can lead to long-term complications or disability. Factors influencing prognosis include the voltage and duration of exposure, the path of the current through the body, and the timeliness of medical intervention. Early and appropriate treatment improves outcomes significantly.

Electrical injuries are caused by exposure to electrical currents. This can occur through direct contact with electrical sources, such as power lines or faulty appliances, or indirectly through conductive materials. The risk is higher in certain occupations, such as electricians or construction workers, but can also occur in everyday settings due to accidents or faulty equipment.

Electrical injuries are relatively uncommon but can have significant consequences. They are more prevalent in industrialized settings and among workers in electrical and construction industries. Children are also at risk, often due to curiosity and lack of awareness about electrical hazards. The incidence of electrical injuries varies globally, influenced by safety standards and access to electricity.

The pathophysiology of electrical injury involves the passage of electric current through the body, which can cause thermal, mechanical, and chemical damage. The current can disrupt cellular function, leading to tissue necrosis, muscle damage, and nerve injury. The heart and nervous system are particularly vulnerable, with potential for arrhythmias and neurological deficits.

Preventing electrical injuries involves adhering to safety protocols and using protective equipment. In occupational settings, this includes regular maintenance of electrical systems, use of insulated tools, and adherence to safety guidelines. In homes, ensuring electrical appliances are in good condition and educating children about electrical safety can reduce risks.

Electrical injury is a potentially serious condition resulting from exposure to electric currents. It can cause a range of symptoms, from minor burns to life-threatening complications. Diagnosis involves clinical evaluation and diagnostic tests, while treatment focuses on stabilization and addressing specific injuries. Prevention through safety measures is key to reducing the incidence of electrical injuries.

If you or someone you know has experienced an electrical injury, it is important to seek medical attention promptly. Symptoms can vary widely, and even minor injuries may require professional evaluation. Understanding the risks and taking preventive measures can help protect against electrical injuries in both occupational and domestic settings.

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.