A 42-year-old man presents to the urgent care clinic after accidentally touching a live wire while attempting to repair his coffee maker. He reports a tingling sensation in his hand at the time of the incident but denies any loss of consciousness, significant pain, or other symptoms. The incident occurred 3 hours prior and he says he is “only here because my partner insisted.” On physical examination, there are no visible burns or other injuries. On examination, he is stable; his initial vital signs are normal and he appears neurologically intact. Which of the following management steps is most appropriate for this patient with a low-voltage electrical injury?
- Contact EMS to transfer the patient to the nearest ED.
- Perform an ECG.
- Order a complete metabolic panel, creatine phosphokinase, complete blood count, and urinalysis.
- Administer IV fluids.
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Answer: B. This patient meets the low-risk criteria (low-voltage injury, no symptoms, no loss of consciousness, and no acute findings on physical examination), so an ECG is the only test needed. There is no indication for IV fluids in this presentation. Because he is asymptomatic with presentation delayed by several hours, this patient can be discharged home if there are no arrhythmias seen on the ECG.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
