The diagnosis of an electrical injury is usually made based on history provided by the patient, bystanders, or emergency medical services. Occasionally, the history may be unclear if the patient is found unconscious in a bathtub or is amnestic to the event. If available, a history should be obtained as to the voltage, the type of current, the duration of contact, the likely pathway of the current, any skin resistance modifying factors (e.g., water or sweating), and any symptoms suggestive of the aforementioned complications. The presence of underlying disease, such as coronary artery disease, diabetes, and neurologic disease, should be determined.
The physical examination should assess tissue damage and identify associated complications. Airway, respiratory, and cardiovascular status should first be stabilized, followed by evaluation for cutaneous burns and secondary trauma. A careful vascular examination of injured extremities must be performed along with a detailed examination of peripheral nerve function. As noted above, occult and delayed injuries occur, and clinicians must be wary that the absence of physical findings does not exclude serious injury.
An electrocardiogram (ECG) and a period of cardiac monitoring is recommended for (1) all patients who have been exposed to high-voltage electricity (more than 600 V) and (2) all patients exposed to low-voltage electricity with suggestive symptoms or signs (loss of consciousness, amnesia, altered mental status, other neurologic symptoms, palpitations, chest pain, or irregular pulse).
Patients with high-voltage injury, extensive cutaneous burns, or evidence of systemic injury require laboratory investigation including a complete blood count and determination of electrolyte, calcium, blood urea nitrogen, creatinine, creatine kinase (CK), and serum myoglobin levels. Urinalysis and determination of the urine myoglobin level should be performed. Urine that tests positive for blood by urine dipstick but has no red blood cells on the microscopic examination is suggestive of myoglobin consistent with muscle damage. Liver function tests and an amylase evaluation should be obtained in those patients who are suspected of having an intraabdominal injury.
Cervical spine films must be obtained in patients who have altered levels of consciousness, neurologic deficits, neck pain or tenderness, or significant distracting injuries. Cranial computed tomography should be performed for those patients who show altered levels of consciousness. Additional studies such as plain films, arteriography for suspected vascular injury, and radionuclide scan to detect cardiac muscle damage should be ordered as needed.
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