Physics

• High-voltage defined as >1,000V
• Voltage related to injuries current via resistance (V=IR)
• AC is 3x more lethal than DC
  • Fluctuation at 60Hz causes tetany, maintained grasp on source

Effects

• Dysrhythmia
  • DC: asystole
  • AC: ventricular fibrillation
  • Delayed dysrhythmia uncommon
• Burn
• Tissue ischemia: vascular spasm or thrombosis
• CNS: AMS, seizure, ICH, neuropathy
• MSK: posterior shoulder dislocation

Management

• Asymptomatic: None
• Mild (i.e. small burn): ECG, UA (rhabdo)
• High voltage: Labs, CT, admit for observation
• Pediatrics: oral commissure burn, discharge with plastic surgery follow-up if no LOC, normal ECG, tolerating PO. Risk of delayed labial artery bleeding.

Complications

• Keraunoparalysis: current travels up and down lower extremities causing transient paresthesia and paralysis.
• Trauma: TM rupture, other mechanical injuries