History and exam
Key diagnostic factors
common
presence of risk factors
Risk factors for electrical injury include: male sex; age <6 years; and construction industry work.
loss of consciousness
Underlying causes include direct effect of electricity on the brain, anoxia due to cardiopulmonary arrest, or head trauma.
May be multifactorial.
pre-hospital CPR or defibrillation
Duration of CPR and use of automatic emergency defibrillation should be documented.
tachycardia
As a result of tachyarrhythmia or response to hypotension.
hypotension
Blood pressure may be low in response to a specific cardiac arrhythmia.
Blood loss from internal trauma and severe burns causes hypotension.
low Glasgow Coma Scale score
Electricity can have direct effects on the central nervous system.
A patient's mental status can also be altered by trauma and anoxia secondary to respiratory arrest or cardiac arrhythmias.
burns
Extent and nature of any skin burns should be documented.
Small area burns might indicate a deeper, more extensive burn.
physical injuries
Secondary injuries such as fractures, contusions, and head injury may be present.
The colon and the small intestine are the most frequently injured visceral organs.[21]
Other diagnostic factors
uncommon
diminished peripheral pulses and poor capillary refill
May indicate hypovolaemic shock or developing compartment syndrome.
low core body temperature
Hypothermia should be suspected when the exact time of injury is unknown, or if the patient might have been immobile on the ground for more than a few minutes.
confusion
Patients may present with an altered mental state. This could be due to a direct effect of electricity on the brain, a result of anoxia from a cardiac arrhythmia, or as a result of secondary trauma.
Risk factors
strong
age <6 years
construction industry workers
Electricians are at risk for electrical shock. Other construction personnel may come into contact with live electrical wires and are at higher risk for accidental electrocution.[12] For example, house painters may accidentally place an aluminium ladder near electrical wires.
male sex
The construction industry is a male-dominated industry, placing men at risk for injury.
weak
participation in outdoor sports
People participating in outdoor sports may be at higher risk of lightning electrocution.[13]
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