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Electrical injury

Complications and Prognosis


Complications
death (electrocution), due to(1)

o direct effects of electrical current, such as asystole, ventricular


fibrillation, or apnea
o blunt mechanical injury, such as muscle contraction or falling after
lightning strike
o conversion of electrical energy to thermal energy resulting in burns

o electroporation due to high strength electrical field exposure (creation of


pores in cell membranes as result of electrical current resulting in cell
death without significant heating)
cardiopulmonary arrest (especially after lightning strike) (3)

arrhythmias (more common with horizontal current flow [such as hand to hand])
(1)

o ventricular fibrillation (more common with low voltage alternating


current)
o asystole (more common with direct current or high voltage alternating
current and with lightning strikes)
o occur in 10%-46% of survivors of electrical shock

most commonly sinus tachycardia and premature ventricular


contractions
less commonly ventricular tachycardia and atrial fibrillation

o usually occur soon after shock but ventricular arrhythmias reported to


occur up to 12 hours after shock
myocardial damage (more common with vertical current flow [such as head to
foot])(1)
o direct electricity exposure

o secondary myocardial injury resulting from induced ischemia

conduction abnormalities(1)

o sinus bradycardia or high-degree atrioventricular block

o may persist long term

keraunoparalysis due to lightning strike(1)

o reversible, transient paralysis associated with sensory disturbances and


peripheral vasoconstriction
o patients may have fixed and dilated pupils (due to autonomic
dysfunction) so presence of these characteristics should not lead to
stopping of resuscitation effort
burns(1)

compartment syndrome(1)

rhabdomyolysis(1)

oral injuries(1)

ruptured tympanic membranes after lightning strike (3)

long term neuropsychological impairment(3)

o fatigue and lack of energy

o irritability and emotional lability

o poor concentration

o mutism, amnesia, and left hemiparesis after high voltage electric shock
with rapid recovery of speech after mild head trauma 2 years later in case
report (Eur Neurol 2011;66(4):229)
fractures and/or large-joint dislocation(1)

o femoral neck fracture due to musculoskeletal contraction after low


voltage electric shock in male aged 41 years in case report (Eur J Trauma
Emerg Surg 2010 Oct;36(5):491 full-text)
o bilateral distal radius fractures in a 12-year-old boy after household
electrical shock in case report (Case Rep Med 2014;2014:235756 full-
text full-text)
o subtrochanteric femur fracture after electric shock in case report (Ann R
Coll Surg Engl 2008 Jan;90(1):W1 PDF)
stroke

o acute ischemic stroke after low voltage electric shock in case report (Surg
Neurol Int 2010 Dec 17;1:83 full-text)
o bilateral mesial occipital lobe infarction after cardiogenic hypotension
due to electrical shock in case report (J Neuroophthalmol 2009
Jun;29(2):107)
additional complications in case reports

o Takotsubo cardiomyopathy ("transient left ventricular apical ballooning


syndrome") after lightning strike (BMJ Case Rep 2009;online full-text)
o myocardial infarction after electric shock (Cardiol J 2009;16(4):362)

o motor neuron disease after electrical trauma in male aged 60 years


(Neurol Sci 2008 Feb;29(1):47EBSCOhost Full Text)
o cerebral corticospinal tract injury after high voltage electric shock (AJNR
Am J Neuroradiol 2008 Jun;29(6):1142 full-text)
o delayed reversible motor neuropathy after low voltage electric shock in
female aged 22 years (J Chin Med Assoc 2008 Mar;71(3):152)
o acute subretinal macular hemorrhage after accidental electric shock (Eye
(Lond) 2006 Dec;20(12):1422EBSCOhost Full Text)
o esophageal stricture after electric shock in male aged 24 years (Indian J
Gastroenterol 2007 Jan-Feb;26(1):40)
Prognosis
mortality rates up to 30% have been reported

o 4.6% mortality reported in cohort of 64 Iranian electrical burn patients


(Burns 2008 Feb;34(1):111)
o 20%-30% case fatality with lightning injuries reported in review article
(Medicina (Kaunas) 2007;43(3):259 [Lithuanian])
most patients surviving cardiopulmonary arrest resume spontaneous breathing
within 1 hour of hospital admission(1)
brainstem reflexes and motor responses may temporarily be absent due to
keraunoparalysis, so prognosis may only be reliable several days after
resuscitation following electrical shock(1)
up to 74% of lightning injuries may have permanent injury (Medicina (Kaunas)
2007;43(3):259[Lithuanian])
neurological and/or neuropsychological symptoms may persist after electric
shock
o based on prospective cohort study

o 114 patients with electric shock and risk factors for late arrhythmias were
followed for symptoms for 1 year
o neurologic or neuropsychological symptoms in

26% at median 52 days

22% patients at 1 year

o Reference - Am J Emerg Med 2008 May;26(4):413

point of entry of current and appearance of neurological injury associated


with presence of paralysis and permanent regional anesthesia
o based on retrospective study of 59 patients with high tension ( 1,000
volts) electrical burn with current passage through body
o voltage not associated with wound severity or percentage of sequelae

o Reference - Burns 1998 Nov;24(7):649


high-voltage electrical injury not associated with long-term myocardial
damage in survivors with preserved left ventricular ejection fraction
o based on small prospective cohort study

o 23 adults with preserved left ventricular ejection fraction after high-


voltage (> 20,000 volts) electrical injury were compared to healthy
controls matched for age, sex, and body mass index
o at 6-month follow-up, no significant difference between groups in

systolic or diastolic blood pressure

heart rate

conventional echocardiographic data

peak systolic strain or strain rate

o Reference - Crit Care 2013 Feb 7;17(1):R26