Electrical Injury: Symptoms, First Aid & Emergency Treatment

What Is Electrical Injury?

Electrical injury occurs when electrical current passes through the body, causing damage to tissues including the skin, muscles, nerves, blood vessels, and heart. The severity ranges from minor discomfort to life-threatening conditions including cardiac arrest, severe burns, and organ damage.

When electricity enters the body, it can travel through various tissues on its way to exit the body or ground. Unlike the controlled electrical signals our bodies naturally use for nerve conduction and heart rhythm, external electrical current can overwhelm these systems and cause immediate damage as well as delayed complications. Understanding how electrical injury works is essential for both prevention and appropriate response when accidents occur.

The human body conducts electricity because it contains water and electrolytes. When external current enters, it follows the path of least resistance, often traveling along blood vessels, nerves, and muscles. The damage caused depends on multiple factors: how strong the current is, how long the body is exposed, the pathway the current takes through the body, and whether moisture is present to reduce skin resistance.

Electrical injuries account for approximately 1,000 deaths annually in the United States and represent about 3-4% of burn center admissions worldwide. While many electrical contacts result in nothing more than an unpleasant sensation, serious electrical injuries can cause hidden internal damage that may not be immediately apparent. This is why medical evaluation is important after any significant electrical exposure.

Factors That Determine Injury Severity

Several key factors determine how severe an electrical injury will be. Understanding these factors helps explain why some electrical contacts cause minor discomfort while others are life-threatening:

• Current strength (amperage): The amount of current flowing through the body is the primary determinant of injury. As little as 100 milliamps across the heart can cause ventricular fibrillation
• Voltage: Higher voltage can drive more current through the body. Injuries are typically classified as low voltage (under 1000V) or high voltage (over 1000V)
• Duration of contact: Longer exposure allows more energy transfer and greater tissue damage. Even low voltage can cause serious injury with prolonged contact
• Current pathway: Current passing through the heart or brain is most dangerous. Hand-to-hand or hand-to-foot pathways are particularly risky because they cross the heart
• Current type: Alternating current (AC) is generally more dangerous than direct current (DC) at equivalent levels because it can cause sustained muscle contraction and tetany
• Skin resistance: Dry skin provides some protection (resistance up to 100,000 ohms). Wet skin drops resistance to as low as 1,000 ohms, allowing much more current to flow

What Are the Types of Electrical Shock?

Electrical shocks are categorized by voltage level and mechanism: minor static electricity discharges, low-voltage household shocks (110-240V), high-voltage industrial or power line injuries (over 1000V), and lightning strikes. Each type presents different risks and requires different responses.

Understanding the different types of electrical exposure helps determine the appropriate level of concern and medical response. While all electrical contact deserves respect, the severity and required treatment vary significantly based on the nature of the exposure.

Minor Static Electricity

Static electricity discharges are the most common form of electrical shock and are almost always harmless. These occur when built-up electrical charge suddenly discharges, such as when touching a metal doorknob after walking on carpet or removing synthetic clothing. The voltage can actually be quite high (several thousand volts), but the current is extremely brief and the total energy transferred is negligible. Static shocks cause a brief, startling sensation but virtually never cause injury.

Low-Voltage Household Shock

Household electrical systems (110V in North America, 220-240V in most other countries) represent the most common source of electrical injuries. These occur from damaged appliances, faulty wiring, wet environments, or inserting objects into outlets. Most brief household shocks cause only temporary discomfort because the body's protective muscle reflex causes rapid withdrawal, or ground fault circuit interrupters (GFCIs) quickly cut the power. However, household current can be dangerous or fatal if contact is prolonged or if the current passes through the heart.

High-Voltage Injuries

High-voltage injuries (over 1000V) typically occur in occupational settings or from contact with power lines. These injuries are almost always serious because high voltage can drive large amounts of current deep into tissues. High-voltage injuries frequently cause:

• Extensive internal burns along the current pathway
• Severe muscle damage and rhabdomyolysis (muscle breakdown)
• Cardiac arrhythmias and potential cardiac arrest
• Deep tissue injury that may not be apparent from surface burns
• Secondary injuries from falls or being thrown by the current

Lightning Strike

Lightning represents a unique form of electrical injury. While the voltage is extraordinarily high (up to 300 million volts), the duration of exposure is extremely brief (microseconds). Lightning injuries often cause cardiac arrest, which may respond to CPR. Surface "flashover" burns in a characteristic pattern (Lichtenberg figures) are common, but deep tissue injury is typically less severe than with sustained high-voltage contact. Lightning can cause immediate cardiac arrest, but survivors have a relatively good prognosis if they receive prompt resuscitation.

What Are the Symptoms of Electrical Injury?

Symptoms of electrical injury include burns at entry and exit points, muscle pain and weakness, irregular heartbeat, difficulty breathing, confusion, numbness or tingling, and in severe cases, loss of consciousness or cardiac arrest. Many serious symptoms can be delayed hours to years.

The symptoms of electrical injury can be divided into immediate symptoms that occur at the time of injury, early symptoms that develop within hours to days, and delayed symptoms that may not appear until weeks, months, or even years later. Recognizing all three categories is crucial because the absence of immediate symptoms does not mean the injury was harmless.

Immediate Symptoms at Time of Injury

When electrical current passes through the body, several immediate effects may occur. Brief, minor shocks may cause only momentary discomfort that resolves within seconds. More significant exposures can cause:

• Burns at contact points: Electrical burns typically appear where current entered and exited the body. These may be surprisingly small compared to the internal damage
• Muscle tetany: Alternating current can cause sustained muscle contraction, potentially preventing the victim from releasing the electrical source
• Loss of consciousness: Current affecting the brain can cause immediate unconsciousness
• Cardiac effects: Arrhythmias or cardiac arrest if current passes through the heart
• Respiratory arrest: Paralysis of breathing muscles if current affects the respiratory center
• Falls and secondary trauma: Being thrown or falling from the electrical contact can cause additional injuries

Early Symptoms (Hours to Days After Injury)

Following a significant electrical injury, additional symptoms often develop in the hours and days that follow. These may indicate ongoing tissue damage or the body's response to the initial injury:

• Muscle pain and weakness: Muscles along the current pathway may become painful, swollen, and weak
• Nausea and dizziness: Common responses to the physiological stress of electrical injury
• Difficulty urinating: The nervous system disruption can affect bladder function
• Red-brown urine: Indicates myoglobin from muscle breakdown, a sign of rhabdomyolysis requiring immediate treatment
• Numbness or altered sensation: Nerve damage may cause areas of numbness or abnormal sensations
• Headaches and confusion: Neurological effects may develop or persist

Delayed Symptoms (Weeks to Years Later)

One of the most challenging aspects of electrical injury is that significant symptoms can appear long after the initial incident. These delayed effects result primarily from progressive nerve damage that was initiated at the time of injury but takes time to manifest. Delayed symptoms may include:

• Chronic pain: Pain at the injury site or along the current pathway can persist or develop, ranging from constant dull aches to intermittent sharp or burning sensations
• Sensory changes: Altered ability to sense temperature, touch, or pressure in affected areas
• Circulation problems: Poor blood flow may cause cold hands and feet, color changes, or Raynaud's phenomenon
• Orthostatic hypotension: Low blood pressure when standing, causing dizziness, weakness, and fainting
• Urinary incontinence: Bladder control problems from nerve damage
• Sexual dysfunction: In men, difficulty achieving or maintaining erection
• Cognitive problems: Memory difficulties, trouble concentrating, and "brain fog"
• Psychological effects: Depression, anxiety, and post-traumatic stress are common after serious electrical injury

When Should You Seek Emergency Care?

Call emergency services immediately if there is difficulty breathing, loss of consciousness, visible burns, irregular heartbeat, muscle cramps or tetany, red-brown urine, or if the person has an implanted cardiac device. Any shock lasting more than one second or involving high voltage requires emergency evaluation.

Most brief, minor electrical shocks from household sources do not require emergency care. The protective muscle reflex typically causes you to pull away before significant injury occurs, and modern ground fault circuit interrupters (GFCIs) in bathrooms and kitchens cut power within milliseconds. However, several situations require immediate emergency attention.

Call Emergency Services (911 or Local Emergency Number) If:

• The person has difficulty breathing or is not breathing
• The person has an irregular pulse or no pulse
• The person has or had seizures
• The person lost consciousness, even briefly
• The person has visible burns, especially at more than one site
• The person has a pacemaker or implanted cardioverter-defibrillator (ICD)
• The shock involved high voltage (power lines, industrial equipment)
• The person was unable to let go of the electrical source (tetanic muscle contraction)
• The incident occurred in water

Seek Same-Day Medical Evaluation If:

Even without the emergency symptoms listed above, you should seek medical evaluation on the same day if:

• The electrical contact lasted more than one second
• You experienced muscle pain, weakness, or stiffness
• You feel persistently dizzy, nauseated, or confused
• You have any concerns about the severity of the exposure
• The shock involved AC power (alternating current) rather than DC

Follow-Up Care After Electrical Injury

If you have been treated for electrical injury or experienced a shock but felt fine afterward, you should contact your healthcare provider if:

• Symptoms that had resolved return
• New symptoms develop in the days, weeks, or months following the injury
• Existing symptoms worsen
• You notice changes in urination, sexual function, or cognitive abilities

What Should You Do If Someone Gets Electrocuted?

First, ensure your own safety by NOT touching the person while they remain in contact with electricity. Turn off the power source if possible. If you cannot turn off power, use a dry non-conducting object to separate them from the source. Then call emergency services and begin CPR if they are not breathing or have no pulse.

Responding to an electrical emergency requires balancing urgency with safety. Your instinct may be to rush to help the victim immediately, but touching someone who is still in contact with an electrical source will result in you becoming a victim as well. Taking a few seconds to ensure scene safety can mean the difference between one victim and two.

Step 1: Ensure Your Own Safety

Before approaching the victim, assess the scene for electrical hazards. Look for the source of the electricity and determine if it is still active. Do NOT touch the person if they are still in contact with the electrical source, even to check for a pulse or breathing. Electricity can flow through the victim into you. If the person is near a downed power line, stay at least 20 feet (6 meters) away and call emergency services immediately.

Step 2: Disconnect the Power Source

If it is safe to do so, turn off the power source:

• Unplug the appliance from the wall
• Switch off the circuit breaker or remove the fuse
• Turn off the main power switch for the building

Step 3: Separate the Person from the Electrical Source (If Power Cannot Be Turned Off)

If you cannot turn off the power, you may need to physically separate the victim from the electrical source. This must be done using only non-conducting materials:

• Use a dry wooden broom handle, plastic chair, rubber mat, or dry rope
• Stand on a dry surface (dry rubber mat, dry wooden board, stack of newspapers)
• Push or pull the person away from the source - do not touch their skin directly
• If pulling by clothing, ensure your hands are dry and use only one hand to minimize current through your body

Step 4: Call Emergency Services

Once the victim is separated from the electrical source, immediately call emergency services. Provide them with:

• Your location
• That this is an electrical injury
• The victim's condition (conscious/unconscious, breathing/not breathing)
• The approximate voltage if known (household vs. high voltage)

Step 5: Provide Emergency Care While Waiting

If the person is not breathing or has no pulse, begin CPR immediately:

1. Place the heel of your hand on the center of the chest
2. Place your other hand on top, interlocking fingers
3. Push hard and fast - at least 2 inches deep, at least 100 compressions per minute
4. If trained, alternate 30 compressions with 2 rescue breaths
5. Continue until emergency services arrive or the person begins breathing

If the person is breathing and conscious:

• Keep them calm and lying down
• Cover them with a blanket to prevent heat loss (shock can cause hypothermia)
• Do not give food or water
• Monitor their condition and be prepared to begin CPR if they stop breathing
• Look for and note the location of any burns for medical personnel

How Is Electrical Injury Diagnosed and Monitored?

Diagnosis involves physical examination to find entry and exit burns, ECG monitoring for cardiac arrhythmias, blood tests for muscle damage markers (CPK, myoglobin), urinalysis for myoglobinuria, and sometimes imaging studies. Patients typically require cardiac monitoring for 24-48 hours after significant exposure.

Medical evaluation of electrical injury is comprehensive because the visible external injuries often underestimate the extent of internal damage. The current may have traveled through muscles, nerves, blood vessels, and organs, causing damage that cannot be seen on physical examination alone.

Physical Examination

The healthcare provider will conduct a thorough physical examination including:

• Skin examination: Looking for entry and exit wounds, which may appear as small burns with white or charred centers
• Cardiovascular assessment: Listening to the heart, checking blood pressure, and feeling pulses
• Neurological examination: Checking sensation, movement, reflexes, and mental status
• Musculoskeletal assessment: Examining for muscle tenderness, compartment syndrome, and secondary trauma from falls

Electrocardiogram (ECG)

An ECG is essential for anyone with a significant electrical injury because the heart is particularly vulnerable to electrical current. The ECG can detect:

• Arrhythmias (irregular heart rhythms)
• Conduction abnormalities (problems with electrical signals in the heart)
• Signs of heart muscle damage

Many patients require continuous cardiac monitoring for 24-48 hours because arrhythmias can develop hours after the initial injury.

Laboratory Tests

Blood and urine tests help assess the extent of tissue damage:

• Creatine phosphokinase (CPK): Elevated levels indicate muscle damage
• Myoglobin: A muscle protein released when muscles are damaged
• Complete blood count: Checks for signs of internal bleeding
• Electrolytes: Can be disrupted by extensive tissue damage
• Kidney function tests: Assesses whether myoglobin is affecting the kidneys
• Urinalysis: Red-brown urine indicates myoglobinuria, a serious complication requiring aggressive treatment

Additional Tests

Depending on the severity and suspected extent of injury, additional tests may include:

• X-rays to check for fractures from falls or muscle contractions
• CT scans for suspected internal injuries
• Compartment pressure measurements if compartment syndrome is suspected
• Ophthalmologic examination for visual symptoms or lightning injury
• Audiologic testing for hearing problems

How Is Electrical Injury Treated?

Treatment depends on injury severity and includes cardiac monitoring, IV fluids to prevent kidney damage from muscle breakdown, wound care for burns, pain management, and sometimes surgery for compartment syndrome or severe burns. Long-term treatment may include physical therapy and psychological support.

Treatment of electrical injury is tailored to the specific injuries sustained and may range from simple observation and wound care to intensive care unit admission for life-threatening complications. The goals of treatment are to stabilize vital functions, prevent complications, treat acute injuries, and provide rehabilitation for long-term effects.

Emergency Treatment

For serious electrical injuries, initial emergency treatment focuses on:

• Airway, breathing, circulation (ABCs): Ensuring adequate oxygenation and blood flow
• Cardiac resuscitation: CPR and defibrillation if in cardiac arrest
• IV fluids: Aggressive fluid replacement to maintain urine output and flush myoglobin through the kidneys
• Cardiac monitoring: Continuous ECG monitoring for arrhythmias
• Pain control: Electrical burns and muscle damage can be extremely painful

Burn Treatment

Electrical burns require specialized care because they often extend deeper than they appear. Treatment may include:

• Wound cleaning and debridement (removal of dead tissue)
• Specialized burn dressings
• Tetanus prophylaxis
• Antibiotics if infection develops
• Skin grafting for larger burns

Surgical Intervention

Surgery may be necessary for:

• Compartment syndrome: Fasciotomy (cutting the fascia) to relieve pressure in muscle compartments
• Extensive burns: Debridement of dead tissue and skin grafting
• Vascular injuries: Repair of damaged blood vessels
• Amputations: In severe high-voltage injuries where tissue cannot be saved

Treating Rhabdomyolysis

Rhabdomyolysis (severe muscle breakdown) is a potentially life-threatening complication that can lead to kidney failure. Treatment includes:

• Aggressive IV fluid administration (often several liters)
• Medications to alkalinize the urine and help clear myoglobin
• Close monitoring of kidney function
• Dialysis if kidney failure develops

Long-Term Treatment and Rehabilitation

Many people with significant electrical injuries require ongoing treatment:

• Physical therapy: To regain strength and function in affected muscles
• Occupational therapy: To adapt to any permanent limitations
• Pain management: Chronic pain is common and may require specialized treatment
• Psychological support: Depression, anxiety, and PTSD are common after electrical injury
• Neurological follow-up: Monitoring for delayed neurological complications

What Happens to the Body During Electrical Injury?

Electrical current can damage all types of tissue in the body including skin, muscles, nerves, blood vessels, and the heart. The damage occurs through direct electrical effects on cell membranes, heat generated by resistance to current flow, and mechanical injury from violent muscle contractions.

Understanding the pathophysiology of electrical injury helps explain why visible injuries often underestimate the true extent of damage and why delayed complications are so common. The human body, with its high water content and electrolytes, is a conductor of electricity. When external current enters the body, multiple damaging mechanisms occur simultaneously.

Direct Electrical Effects

Electrical current directly affects cell function by disrupting the electrical potential across cell membranes. This is particularly important for "excitable" tissues like nerves and muscles that rely on controlled electrical signals for normal function. The heart, which depends on precisely coordinated electrical activity, is especially vulnerable. Direct electrical effects can cause:

• Cell membrane damage and cell death
• Disruption of nerve impulse transmission
• Cardiac arrhythmias or arrest
• Muscle tetany (sustained contraction)

Thermal (Heat) Injury

As electrical current flows through tissues, resistance to that flow generates heat (Joule heating). Tissues with higher resistance, like bone, generate more heat. This can cause:

• Burns at entry and exit points where current is concentrated
• Deep tissue burns along the current pathway
• Thermal damage to blood vessels causing delayed thrombosis
• Bone necrosis (death) in severe cases

Mechanical Injury

The violent muscle contractions caused by electrical current can cause:

• Fractures, particularly of the spine and long bones
• Joint dislocations
• Muscle tears
• Falls from the force of muscle contraction

Why Nerve Damage Is Often Delayed

One of the most puzzling aspects of electrical injury is why neurological symptoms often appear or worsen weeks to years after the injury. This occurs because damaged nerve cells may continue to function initially but then progressively deteriorate. The initial injury starts a process of nerve degeneration that takes time to manifest as symptoms. This is why patients are advised to report any new symptoms that develop after electrical injury, even if they initially seemed to recover completely.

How Can You Prevent Electrical Injuries?

Prevent electrical injuries by installing and testing GFCIs in wet areas, never using electrical devices near water, replacing damaged cords immediately, not overloading outlets, keeping children away from outlets, and having electrical systems inspected regularly. Outdoor safety includes avoiding power lines and seeking shelter during storms.

Most electrical injuries are preventable through awareness, proper maintenance, and simple safety practices. The majority of household electrical injuries occur from easily avoidable situations like using electrical devices near water or ignoring damaged cords.

Home Electrical Safety

• Install GFCIs: Ground fault circuit interrupters should be installed in bathrooms, kitchens, laundry rooms, garages, and outdoor areas. Test them monthly by pressing the "test" button
• Replace damaged cords immediately: Never use appliances with frayed, cracked, or damaged cords
• Don't overload outlets: Avoid plugging multiple high-power devices into one outlet or using multiple extension cords
• Keep electrical devices away from water: Never use hairdryers, radios, or other electronics near bathtubs, sinks, or pools
• Use outlet covers: Protect children by covering unused outlets
• Have wiring inspected: Older homes should have electrical systems checked by a licensed electrician

Child Safety

Children are particularly curious about electrical outlets and cords. Protect them by:

• Using tamper-resistant outlets or outlet covers
• Keeping cords out of reach
• Teaching children about electrical dangers at an age-appropriate level
• Never allowing children to play with electrical devices
• Supervising children near any electrical equipment

Outdoor and Lightning Safety

• Stay away from power lines: Never touch downed power lines or anything in contact with them
• Use caution with ladders and tools: Keep them away from overhead power lines
• Call before digging: Buried power lines can cause serious injuries
• Seek shelter during storms: When thunder roars, go indoors. If caught outside, avoid tall objects, water, and metal
• Wait 30 minutes after the last thunder before going outside