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Current passing through skeletal muscle can cause muscle necrosis and contractions severe enough to result in bone fracture Current traversing peripheral nerves can cause acute or delayed neuropathy Delayed effects can include damage to the eye, spinal cord, peripheral nerves, bone, kidneys, and gastrointestinal tract If the current passes through the heart or brainstem, death may be immediate due to ventricular fibrillation, asystole, or apnea With alternating currents (AC) of 25 300 Hz, low voltages (< 220 Hz) tend to produce ventricular fibrillation; high voltages (> 1000 Hz) cause respiratory failure; intermediate voltages (220 1000 Hz) cause both More than 100 mA of domestic house AC of 110 volts at 60 Hz is, accordingly, dangerous to the heart, since it can cause ventricular fibrillation Direct current (DC) contact is more likely to cause asystole Lightning injuries differ from high-voltage electric shock injuries; lightning usually involves higher voltage, briefer duration of contact, asystole, nervous system injury, and multisystem pathologic involvement Electrical burns are of three distinct types: flash (arcing) burns, flame (clothing) burns, and the direct heating effect of tissues by the electric current The latter lesions are usually sharply demarcated, round or oval, painless yellow-brown areas (Joule burn) with inflammatory reaction Significant subcutaneous damage can be accompanied by little skin injury, particularly with larger skin surface area electrical contact

Electric shock may produce loss of consciousness With recovery there may be muscular pain, fatigue, headache, and nervous irritability The physical signs vary according to the action of the current Ventricular fibrillation or respiratory failure or both can occur; the patient may be unconscious, pulseless, hypotensive, cold and cyanotic, and without respirations

The victim must be separated from the electric current prior to initiation of CPR or other treatment; the rescuer must be protected Turn off the power, sever the wire with a dry wooden-handled ax, make a proper ground to divert the current, or separate the victim using nonconductive implements such as dry clothing

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Lightning or unstable electric shock victims should be hospitalized when revived and observed for shock, arrhythmia, thrombosis, infarction, sudden cardiac dilation, hemorrhage, and myoglobinuria A urinalysis, urine myoglobin, serum creatine kinase and creatine kinase-MB, and an ECG should be obtained immediately Victims should also be evaluated for hidden injury (eg, ophthalmic, otologic, muscular, compartment syndromes), organ injury (myocardium, liver, kidney, pancreas), blunt trauma, dehydration, skin burns, hypertension, posttraumatic stress, acid-base disturbances, and neurologic damage Indications for hospitalization include significant arrhythmia or ECG changes, large burn, loss of consciousness, pulmonary or cardiac symptoms, or evidence of significant deep tissue or organ damage Extra caution is indicated when the electroshock current has followed a transthoracic route (hand to hand or hand to foot) and in patients with a cardiac history To counteract fluid losses and myoglobinuria due to electric shock (not lightning) burns, aggressive hydration with Ringer s lactate should seek to achieve a urinary output of 50 100 mL/h

Complications may occur in almost any part of the body but most commonly include sepsis; gangrene requiring limb amputation; or neurologic, cardiac, cognitive, or psychiatric dysfunction Psychiatric support may be necessary following lightning or severe electroshock exposures

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