Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Electrical Injury

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In one line

·Electrical injury occurs when current passes through the body, causing burns, heart rhythm problems, muscle damage, and organ injury that is often worse inside than it looks on the skin.

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Normal physiology

·Skin has high resistance to electricity, acting like a barrier that stops small currents from entering the body. Internally, the body's tissues conduct electricity at different rates—nerves and blood vessels conduct easily, while bone resists strongly.

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What goes wrong

·When electrical current strong enough to overcome skin resistance enters the body, it flows through the path of least resistance—usually blood vessels, nerves, and muscles—burning and damaging everything along that path, while the heart's normal electrical rhythm gets disrupted or stops.

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Hallmark signs

·Skin burns at entry and exit points
·Muscle pain, swelling, or weakness in arms or legs
·Heart rhythm problems (arrhythmias) or cardiac arrest
·Numbness, tingling, or loss of movement
·Confusion, memory loss, or seizures
·Dark or cola-colored urine
·Broken bones or dislocated joints
·Lichtenberg figures (fern-like skin marks after lightning)

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Red flags · escalate now

·Heart rhythm is irregular, too fast, too slow, or the person has chest pain
·Urine is dark brown, red, or cola-colored (sign of muscle breakdown clogging the kidneys)
·Severe swelling, numbness, or pain in an arm or leg that gets worse (compartment syndrome building pressure)
·Confusion, seizures, or the person is unconscious or hard to wake up
·High-voltage exposure (power lines, industrial equipment) even if burns look small on the outside

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Workup

·Continuous cardiac monitoring (ECG, telemetry) for 24–48 hours
·Creatine kinase (CK) — blood test
·Troponin I or T — blood test
·Basic metabolic panel (BMP) — blood test for electrolytes and kidney function
·Urine myoglobin or urinalysis with dipstick
·Complete blood count (CBC)
·X-rays of chest, spine, and any painful area
·Compartment pressure measurement (if swelling is severe)

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Treatment

·Continuous cardiac monitoring for 24–48 hours
·Aggressive IV fluids (lactated Ringer's or normal saline) to keep urine output > 200 mL/hour (in adults)
·Check for compartment syndrome; perform fasciotomy if pressure > 30 mmHg or clinical signs are severe
·Treat arrhythmias per ACLS protocols (defibrillation for ventricular fibrillation, pacing for heart block, medications like amiodarone or lidocaine)
·Tetanus prevention (prophylaxis) (vaccine and/or immunoglobulin based on history)
·Surgical debridement (cutting away dead tissue) and wound care; early surgical consult for high-voltage injury
·Ophthalmology referral if current passed near the eyes; monitor for cataracts for up to 3 years

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NCLEX trap

·The skin burn is just the tip of the iceberg. Electricity travels deep inside the body and cooks muscles, nerves, and blood vessels that you cannot see from the outside. The real damage is hidden under the skin. Always look for swelling, dark urine, and tight, painful muscles that can signal compartment syndrome.
·Even low-voltage shocks (like household current) can mess up the heart's rhythm hours later. High-voltage injuries (power lines, industrial equipment) carry even higher risk. Current guidelines say to watch the heart on a monitor for at least 12 to 24 hours if the voltage was high, the shock crossed the chest, the person lost consciousness, or they have any abnormal EKG or symptoms.
·Dark urine after electrical injury means the muscles are breaking down (rhabdomyolysis). Muscle cells spill a protein called myoglobin into the blood, and myoglobin clogs the kidney filters like sand clogging a drain. You must give IV fluids fast—often 500 to 1,000 mL per hour or more—to make lots of urine and flush the myoglobin out before the kidneys fail. Aim for urine output over 200 mL per hour until the urine is clear.
·Electricity cooks the deep muscles even when the skin looks fine. The cooked muscle swells inside a tight sleeve of tough tissue called fascia. This traps blood and squeezes arteries and nerves, causing compartment syndrome. If pressure gets too high, the tissue dies in hours. You may need emergency surgery (fasciotomy) to cut open the fascia and release the pressure. Signs include pain out of proportion, pain with stretching, tight swelling, numbness, and weak pulses.
·Electricity makes every muscle in the body contract at once—often so hard that the person is thrown across the room, falls off a ladder, or fractures bones from the force of their own muscle contraction. Always do a full trauma exam: check the spine, feel the bones, look for head injury, and ask if they fell or were thrown. High-voltage injuries frequently cause fractures of the shoulder, spine, and long bones.
·ABCs always come first: Airway, Breathing, Circulation. Electricity can stop breathing by freezing the chest muscles or damaging the brain's breathing center. No heart medicine works if the lungs are not moving oxygen. Secure the airway, start rescue breathing or intubate if needed, then move to the heart. This is basic resuscitation order for any critically ill patient.

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