Electrical Injury: Symptoms, First Aid & Emergency Treatment

What Is an Electrical Injury?

An electrical injury occurs when electric current passes through the body, causing damage to tissues, organs, and body systems. The severity depends on the voltage, current strength, pathway through the body, duration of contact, and the type of current (AC or DC). Injuries can range from minor skin burns to fatal cardiac arrest.

When electric current flows through the human body, it can disrupt normal electrical signals, generate heat that burns tissues, and cause mechanical trauma from muscle contractions. The damage caused by electrical injuries is often much more extensive internally than what is visible on the skin surface, making these injuries particularly challenging to assess and treat.

Electrical injuries are categorized based on voltage levels. Low-voltage injuries involve exposure to less than 1,000 volts, which includes standard household electricity (110-240V depending on country). High-voltage injuries involve more than 1,000 volts and typically occur in industrial settings or from contact with power lines. High-voltage injuries are significantly more severe and have a much higher mortality rate.

The human body is an electrical conductor, and current will flow through it when it becomes part of an electrical circuit. The path the current takes through the body determines which organs are affected. A hand-to-hand pathway passes through the chest and heart, making it particularly dangerous. A hand-to-foot pathway also crosses the heart and is similarly life-threatening.

Factors That Determine Injury Severity

Several factors influence how severely an electrical injury affects the body. Understanding these factors helps explain why some electrical exposures cause minimal harm while others prove fatal:

• Current strength (amperage): The amount of current flowing through the body is the primary determinant of injury severity. As little as 100 milliamps can cause fatal ventricular fibrillation
• Duration of contact: Longer exposure allows more energy to be transferred to tissues, causing greater damage
• Contact area: A larger surface area in contact with the electrical source spreads the current and may reduce localized damage
• Current pathway: Current passing through the heart or brain causes the most severe and potentially fatal injuries
• Simultaneous grounding: Contact with water, metal surfaces, or the ground while being shocked increases current flow and injury severity

Types of Electrical Current

Alternating current (AC) and direct current (DC) affect the body differently. AC, which is used in household and commercial power supplies, is generally more dangerous than DC at the same voltage. This is because AC causes sustained muscle contraction (tetany) that prevents the victim from releasing their grip on the electrical source, leading to prolonged exposure. The alternating nature of AC also makes it more likely to disrupt the heart's electrical rhythm.

DC, found in batteries and some industrial equipment, tends to cause a single muscle contraction that often throws the victim away from the source. While this can cause traumatic injuries from the fall, it typically results in shorter exposure times. However, high-voltage DC exposures remain extremely dangerous and can cause the same internal injuries as AC.

What Happens After a Mild Electric Shock?

A mild electric shock typically causes brief discomfort, a tingling sensation, and possibly localized pain at the contact point. Most people experience no lasting effects when contact is less than one second, and the body's protective muscle reflex pulls them away from the source or a circuit breaker interrupts the current.

When you touch a faulty electrical appliance or outlet at home, you usually experience what is called a low-voltage shock. In most cases, the exposure lasts less than a second because of two protective mechanisms: the body's involuntary muscle reflex that jerks the affected body part away from the current source, and modern electrical systems that include circuit breakers or ground fault interrupters that cut power when they detect abnormal current flow.

After a mild shock, you may experience pain at the contact site that can radiate to surrounding areas. This discomfort typically resolves within minutes to hours. It is completely normal to feel frightened or shaken after even a minor electrical exposure, as the sudden, unexpected sensation can be quite startling. In most cases, there are no permanent effects from brief, low-voltage shocks.

Common sources of mild household electric shocks include recently unplugged electrical cords that retain a small charge, static electricity buildup (particularly common in dry conditions or when wearing synthetic clothing), and brief contact with faulty appliances or damaged cords. Electric fences around livestock areas deliver intentionally mild shocks designed to deter animals without causing injury.

What Are the Signs of a Serious Electrical Injury?

Serious electrical injuries cause severe symptoms including burns at entry and exit points, muscle spasms or tetany, difficulty breathing, loss of consciousness, cardiac arrhythmias, and seizures. High-voltage exposure or prolonged contact dramatically increases the risk of life-threatening complications.

A serious electrical injury occurs when significant current flows through the body for more than a brief moment, or when the victim is exposed to high voltage. These injuries can happen from household electricity if contact is prolonged (more than one second), or from exposure to high-voltage sources such as power lines, industrial equipment, or lightning strikes.

The mechanism of serious electrical injury involves multiple pathways of damage. Electrical current disrupts the normal electrical activity of the heart and nervous system. The resistance of tissues to current flow generates heat, causing burns both at the skin surface and deep within muscles and organs along the current's path. Severe muscle contractions can cause fractures, dislocations, and compartment syndrome.

Immediate Symptoms of Severe Electrical Injury

Victims of serious electrical injury may experience one or more of the following symptoms immediately after the event:

• Burns at entry and exit points: These may appear as small, charred areas but often indicate extensive internal damage along the current's pathway
• Numbness or decreased sensation: Nerve damage can cause loss of feeling at the contact site and along the affected limb
• Muscle pain and weakness: Electrical current causes intense muscle contractions that can leave muscles sore and weak
• Nausea and dizziness: Common symptoms resulting from disruption of the autonomic nervous system
• Difficulty urinating: Kidney damage or muscle breakdown can affect urinary function
• Red-brown urine: This indicates rhabdomyolysis, a serious condition where damaged muscles release proteins into the bloodstream

Delayed Symptoms After Electrical Injury

One of the most challenging aspects of electrical injury is that many symptoms do not appear until days, weeks, months, or even years after the initial incident. This delayed presentation occurs because nerve damage may initially be subclinical, with symptoms emerging only as damaged neurons fail over time.

Delayed symptoms can include chronic pain at the injury site that may be constant or intermittent, with some patients describing sharp, burning, or shooting sensations. Temperature sensitivity changes are common, with affected areas becoming unable to properly sense heat or cold. Circulatory problems may develop, including Raynaud's phenomenon where fingers and toes turn white in cold conditions.

Cardiovascular effects can emerge over time, including orthostatic hypotension (feeling dizzy when standing up quickly), palpitations, and in some cases, delayed arrhythmias. Neurological complications include peripheral neuropathy, difficulty with concentration and memory, headaches, and changes in balance or coordination. Psychological effects are also common and can include anxiety, depression, post-traumatic stress disorder, and sleep disturbances.

When Should You Seek Medical Care?

Seek immediate emergency care for any high-voltage exposure, loss of consciousness, difficulty breathing, burns, irregular heartbeat, prolonged contact (more than 1 second), or if the current passed through the chest. Even minor shocks warrant medical evaluation if symptoms persist or if you have a pacemaker or other implanted device.

Most brief, low-voltage electric shocks do not require emergency medical treatment. The discomfort typically resolves on its own within hours. However, certain circumstances always warrant immediate medical evaluation, regardless of how the person feels initially.

The challenge with electrical injuries is that internal damage may be extensive even when external signs are minimal. A small entry wound on the skin can hide significant damage to muscles, blood vessels, and nerves along the current's pathway. Additionally, cardiac effects may not be immediately apparent but can cause dangerous arrhythmias hours after the exposure.

Seek Emergency Care Immediately If:

• Difficulty breathing or not breathing at all: Indicates respiratory arrest or severe chest muscle damage
• Irregular pulse or no pulse: Signs of cardiac arrhythmia or arrest requiring immediate CPR
• Seizures or muscle cramps: Indicates significant neurological involvement
• Loss of consciousness: Even brief unconsciousness suggests serious injury
• Pacemaker or ICD: Any electrical exposure in someone with an implanted cardiac device requires evaluation
• Visible burns: Entry and exit burns indicate current has passed through the body
• High-voltage exposure: Any contact with power lines or industrial electricity

Seek Prompt Medical Attention If:

Contact a healthcare provider or visit an urgent care facility if you experience symptoms that were initially mild but have returned or worsened, if you have new symptoms developing after an electrical injury, or if you remain concerned about any aspect of your exposure. Documentation of the incident in your medical record is important, as delayed symptoms may emerge later and having the initial exposure recorded aids in diagnosis and treatment.

How Do You Help Someone Who Is Being Electrocuted?

First, ensure your own safety - never touch someone in direct contact with electricity. Disconnect the power at the source, or if that is not possible, use a non-conducting object to separate the person from the electrical source. Once safe, call emergency services immediately and provide CPR if the person is not breathing or has no pulse.

Witnessing someone being electrocuted is frightening, but acting quickly and correctly can save their life. The most critical principle is protecting yourself from becoming a second victim. Touching someone who is in contact with an electrical source can cause the current to flow through you as well, potentially causing two casualties instead of one.

Your immediate priority is breaking the electrical circuit. If possible, turn off the electricity at the circuit breaker, fuse box, or by unplugging the device. In industrial settings or outdoor situations involving power lines, stay at least 6 meters (20 feet) away and call emergency services immediately - do not approach until utility workers have confirmed the power is off.

Step-by-Step First Aid for Electrical Injury

1. Disconnect the Power

Locate and turn off the power source immediately. This might mean switching off the circuit breaker, unplugging the appliance, or turning off the main power supply. If outdoors, call emergency services and wait for professionals to handle power lines.

2. Separate the Person from the Source

If you cannot disconnect the power, you must physically separate the victim from the electrical source without touching them directly. Use a non-conducting object such as a dry wooden board, a thick stack of newspapers, a rubber mat, dry rope, or plastic. Never use anything wet or metallic. Push or pull the person away from the source, being careful not to touch their skin.

3. Call Emergency Services

Once the person is safely away from the electrical source, call your local emergency number immediately. Describe the situation clearly, including that it was an electrical injury, the person's current condition, and whether they are breathing.

4. Check Breathing and Pulse

Once it is safe to touch the person, check if they are breathing and have a pulse. If they are not breathing or have no pulse, begin CPR immediately. Continue until emergency medical services arrive.

5. Treat for Shock and Burns

Keep the person lying down in a comfortable position. If they are conscious, reassure them that help is coming. Cover any burns loosely with a sterile bandage or clean cloth - do not apply ice, water, or ointments to electrical burns. Keep the person warm while waiting for emergency services.

How Are Electrical Injuries Diagnosed and Evaluated?

Medical evaluation of electrical injury includes a complete physical examination, electrocardiogram (ECG) to check heart rhythm, blood tests to assess muscle damage and kidney function, urine tests for myoglobin, and potentially imaging studies. Patients may need cardiac monitoring for 24 hours or longer after high-voltage exposure.

The diagnosis and evaluation of electrical injuries requires a systematic approach because damage may not be immediately apparent. Healthcare providers must assess both the obvious injuries and search for hidden damage that is characteristic of electrical trauma. The evaluation typically begins in the emergency department and may extend to specialist consultations depending on the severity of the injury.

A thorough physical examination focuses on identifying entry and exit wounds, assessing neurological function, evaluating the cardiovascular system, and checking for signs of trauma from falls or muscle contractions during the shock. The physician will examine the skin carefully for burns, which may appear deceptively small despite extensive internal damage.

Diagnostic Tests

Electrocardiogram (ECG): This is essential for all significant electrical injuries. The ECG detects arrhythmias, conduction abnormalities, and signs of cardiac damage. Continuous cardiac monitoring is typically required for at least 24 hours after high-voltage injuries or when the initial ECG shows any abnormalities.

Blood tests: Laboratory evaluation includes complete blood count, comprehensive metabolic panel, creatine kinase (CK) levels to assess muscle damage, and troponin levels to evaluate cardiac injury. Elevated CK indicates rhabdomyolysis, which requires aggressive IV fluid treatment to protect the kidneys.

Urinalysis: Testing for myoglobin in the urine helps identify rhabdomyolysis. Red-brown urine or positive myoglobin indicates significant muscle breakdown requiring immediate treatment.

Specialist Consultations

Depending on the injury pattern and severity, various specialists may be involved in care. These can include burn surgeons for wound management, cardiologists for heart-related complications, neurologists for nerve and brain injuries, orthopedic surgeons for fractures and compartment syndrome, ophthalmologists for eye injuries (cataracts can develop even years after electrical injury), and psychiatrists or psychologists for psychological support and PTSD treatment.

How Are Electrical Injuries Treated?

Treatment depends on injury severity and may include cardiac monitoring, IV fluids to protect kidneys from muscle breakdown products, wound care for burns, pain management, and surgery for severe tissue damage. Long-term treatment often involves physical therapy, psychological support, and management of delayed complications.

The treatment approach for electrical injuries varies dramatically based on severity. Minor low-voltage injuries may require only observation and symptomatic treatment, while severe high-voltage injuries often necessitate intensive care, multiple surgeries, and prolonged rehabilitation.

Acute Treatment

Resuscitation: For patients with cardiac arrest or respiratory failure, immediate advanced cardiac life support (ACLS) is essential. Electrical injuries have better outcomes from CPR than many other causes of cardiac arrest, making aggressive resuscitation efforts particularly important.

Fluid resuscitation: Aggressive IV fluid therapy protects the kidneys from damage caused by myoglobin released from injured muscles. The target is to maintain adequate urine output, typically 1-2 mL/kg/hour. In severe cases, alkalinization of the urine may be used to enhance myoglobin clearance.

Wound care: Electrical burns require specialized care. Unlike thermal burns, electrical burns often have small surface wounds with extensive deep tissue damage. Initial management includes cleaning, debridement of dead tissue, and appropriate dressings. Tetanus prophylaxis is administered if not current.

Pain management: Electrical injuries can cause severe pain from burns, muscle damage, and nerve injury. Appropriate pain control is an important part of treatment and may include various medications depending on pain severity and location.

Surgical Treatment

Severe electrical injuries frequently require surgical intervention. Fasciotomy may be necessary to relieve compartment syndrome caused by swelling within muscle compartments. Debridement removes dead tissue that could become infected. Skin grafting may be required for extensive burn wounds. In severe cases, amputation may be necessary when limb damage is too extensive for reconstruction.

Long-Term Management

Recovery from significant electrical injury often extends over months to years. Physical therapy helps restore function and strength to affected limbs. Occupational therapy assists with returning to daily activities and work. Psychological support addresses the emotional trauma, anxiety, depression, and PTSD that commonly follow electrical injuries. Regular follow-up monitors for delayed complications including cataracts, neurological deterioration, and chronic pain syndromes.

What Happens in the Body During an Electrical Injury?

Electric current affects all tissues it passes through, causing damage via heat generation, disruption of electrical signals in nerves and heart, and mechanical trauma from muscle contractions. The current can take various pathways through the body and may divide, making it difficult to predict or identify all areas of damage.

Understanding the pathophysiology of electrical injury helps explain why these injuries are so challenging to diagnose and treat. When current enters the body, it follows the path of least resistance, which is generally through blood vessels, nerves, and muscles rather than fat or bone. This means that internal tissues often sustain more damage than the skin.

The body's tissues have different electrical resistance levels. Blood vessels and nerves have low resistance and conduct current easily, making them particularly vulnerable to damage. Bone has high resistance and generates significant heat when current passes through, potentially causing necrosis at points where nerves and vessels contact bone.

Mechanisms of Tissue Damage

Thermal injury: As current flows through tissues, resistance generates heat according to Joule's law. This heat can cause coagulation necrosis of tissues along the current pathway. The damage often extends beyond what is visible, as heat generated in deep tissues may not reach the skin surface.

Electrical disruption: The heart and nervous system rely on precise electrical signals to function. External electrical current can override or disrupt these signals, causing arrhythmias, seizures, and loss of consciousness. The heart is particularly vulnerable when current passes through the chest.

Mechanical trauma: Intense muscle contraction during electrical exposure can cause fractures (particularly of the spine), dislocations, and tendon ruptures. Victims may also suffer trauma from falls if they are thrown or fall from heights.

Delayed Nerve Damage

Many delayed symptoms following electrical injury result from progressive nerve damage. Initially, nerve function may appear normal, but over days to weeks, damaged neurons begin to fail. This explains why symptoms such as weakness, numbness, chronic pain, and cognitive difficulties can emerge long after the initial injury. The exact mechanism is not fully understood but likely involves a combination of direct electrical damage, ischemia from blood vessel injury, and inflammatory processes.

Frequently Asked Questions