Electrical Injuries July 2022 Question – In Collaboration with EMCoach

Topic: Environmental Exposures
Section: Electrical Injury
Acuity: Emergent
Age group: Adult

A 30-year-old female presents to the emergency department complaining of an electric shock to her hand from a household outlet while doing electrical work on her home. She reports no symptoms and has a normal physical exam. Her electrocardiogram is as shown. Which of the following is the most appropriate next step in management?

Correct answer:
B. Discharge home
Low voltage injuries <600 V are commonly caused by home outlets. In the United States, outlets are 120 V, while in Europe and Australia they are 240 V. The electrocardiogram shown is normal. Asymptomatic patients with normal ECG’s on arrival to the hospital can be safely discharged from the ED.
 
Incorrect answer choices:
Cardiac monitoring (Choice A) and ED observation (Choice C) are not required for asymptomatic patients with a normal ECG after a low voltage electrical injury. Patients who feel unwell or have any new ECG abnormality should be monitored for 6 hours and reassessed. Laboratory testing (Choices D and E) and imaging are usually not required unless the patient is symptomatic or has abnormal physical examination findings. Patients with criteria in the below table should be admitted for electrocardiographic monitoring following electrical injury.

See the video below for a video explanation of this month’s question:

Additionally, here is a table for who should be admitted for electrocardiographic monitoring following electrical injury.

References:

Gentges, J, Schieche, C. Electrical Injuries in the Emergency Department: An Evidence-Based Review. EB Medicine. November 1, 2018. Accessed June 15, 2022. https://www.ebmedicine.net/topics/burns/electric-shock-burns (full free access for residents)

Bailey C. Chapter 218. Electrical and Lightning Injuries. In: Tintinalli JE, Stapczynski JS, Ma OJ, et al. <em>Tintinalli’s Emergency Medicine: A Comprehensive Study Guide</em>. 8th ed. New York: McGraw Hill Professional; 2016.

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