EM · Electrical and lightning injury
Electrical and lightning injury
Also known as Electrocution · Electrical burn · Lightning strike · High-voltage injury · Keraunopathy
Electrical and lightning injury — low-voltage (under 1000 V) shocks cause local contact burns and arrhythmia; high-voltage (over 1000 V) injury drives deep tissue destruction along the current path with rhabdomyolysis, myoglobinuria, compartment syndrome and cardiac arrest; lightning causes cardiopulmonary arrest, Lichtenberg figures and tympanic rupture. Management is ABCDE trauma resuscitation, ECG monitoring for 4 to 6 hours, creatine kinase and urine output surveillance, fasciotomy for compartment syndrome, and treating every case as blunt trauma. Distinguished from thermal burn, tricyclic poisoning and blunt trauma. ACEM-primary, globally tagged.
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8 MCQs with explanations
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Meet the patient
A linesman is brought in after contacting an 11,000 V overhead line. He is alert, with a small charred puncture on his right palm — and dark urine in the catheter bag. The entry wound looks trivial; the limb beneath is dying along the bone.[1]
Three threats are running on three clocks: the arrhythmia (now, on the monitor), the rhabdomyolysis (hours, in the urine and the rising CK), and the compartment syndrome (hours, in the tense painful forearm). Treat the trauma, watch the trace, load the fluids, and measure the compartment before the golden period closes — a small surface wound with a high-voltage history hides deep necrosis beneath.[1]
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- [1]Smith I. Assessment and Management of Electrical Injuries in Adults in the Emergency Department Cureus, 2026.PMID 42147553
- [2]Yazıcı R, Bulut B, Genç M, et al. Prevalence and risk factors of developing cardiac arrhythmia in patients presenting to the emergency department with electrical injuries PLoS One, 2025.PMID 41364707
- [3]Samia AM, et al. Cutaneous Manifestations of Lightning Injury: A Review of the Literature Skinmed, 2023.PMID 37634096
- [4]Jensen PJ, Thomsen PE, Bagger JP, et al. Electrical injury causing ventricular arrhythmias Br Heart J, 1987.PMID 3566986
- [5]Sawhney JS, et al. Management of rhabdomyolysis: A practice management guideline from the Eastern Association for the Surgery of Trauma Am J Surg, 2022.PMID 34836603
- [6]Pedrazzi N, et al. Predictors for limb amputation and reconstructive management in electrical injuries Burns, 2023.PMID 36031494
- [7]Putri AC, et al. The Evaluation of a Golden Period of Fasciotomy for High Voltage Electrical Burn Injury Patients With Compartment Syndrome Ann Burns Fire Disasters, 2023.PMID 38680908