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.

medium16 referencesUpdated 26 July 202618 min readVerification in progress

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8 MCQs

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]

References16Show

[1]Smith I, et al. 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
[8]Long B, Koyfman A, Gottlieb M. An evidence-based narrative review of the emergency department evaluation and management of rhabdomyolysis. Am J Emerg Med, 2019.PMID 30630682
[9]Waldmann V, et al. Electrical cardiac injuries: current concepts and management. Eur Heart J, 2018.PMID 28444167
[10]Seyfrydova M, et al. Arrhythmias and laboratory abnormalities after an electrical accident: a single-center, retrospective study of 333 cases. Clin Res Cardiol, 2023.PMID 37526697
[11]Jacob NE, M R. Keraunoparalysis: Fleeting Paralysis Following a Lightning Flash. Cureus, 2024.PMID 39493204
[12]Cooper MA. Emergent care of lightning and electrical injuries. Semin Neurol, 1995.PMID 8570929
[13]Vilke G, et al. Emergency Department Evaluation After Conducted Energy Weapon Use: Review of the Literature for the Clinician. J Emerg Med, 2019.PMID 31500994
[14]Canady JW, et al. Oral commissure burns in children. Plast Reconstr Surg, 1996.PMID 8628768
[15]Jain V, et al. Guidelines for the Management of a Pregnant Trauma Patient. J Obstet Gynaecol Can, 2015.PMID 26334607
[16]Spies C, Trohman RG. Narrative review: Electrocution and life-threatening electrical injuries. Ann Intern Med, 2006.PMID 17015871