TABLE 1969 Indications for Admission

Adults with low-voltage injury (less than 600 V) and evidence of complications should be admitted. Multiple studies have substantiated the negligible risk of delayed arrhythmias in asymptomatic patients with a 110-V exposure and no tetany, wet skin, or vertical current flow. Asymptomatic adults who sustain a household shock may be discharged home if they have a normal ECG on presentation and normal examination findings.9 Exposure to 220 V probably carries little risk for occult or delayed cardiac injury, although the published literature is less than definite. Two studies totaling 90 patients from Australia where household current is single-phase AC at 50 Hz with voltage varying between 220 and 260 V found that only one patient sustained an arrhythmia, and that was present on admission. 1314

Children with exposure or injury to 110-V household current usually sustain oral burns or minor hand burns and rarely develop cardiac or significant deep injury. 1516 and H Children with an electrical cutaneous burn and a loss of consciousness, vertical current path, tetany, or wet skin should be admitted for a period of cardiac monitoring.16!7 Likewise, a child with a home situation of equivocal safety or reliability should also be admitted, although cardiac monitoring is not routinely required for these "social" admissions. Children with minor hand burns from outlet injuries and no initial evidence of cardiac or neurovascular injury can also be sent home with local wound care.18

Oral electrical burns in children have been extensively studied. 19 Because of the risk of wound contracture and delayed hemorrhage, such children were formerly commonly admitted to the hospital for observation and the initiation of splinting. More recent series indicate that most children with oral electrical burns do not require admission, provided (1) there is no history of loss of consciousness, (2) there are no other injuries that require admission, (3) the ECG is normal, (4) the child is able to drink fluids, and (5) the parents are reliable.17 These children can be discharged home with instructions to apply pressure should the oral burn bleed, return in 24 h for a wound check, and arrange follow-up with a plastic or oral surgeon. The risk of cardiac or muscle damage is so low that urinalysis, CK, and myoglobin testing is not required.16 Prolonged cardiac rhythm monitoring is not necessary, provided the initial ECG is normal. Splinting for a minimum of 4 months is beneficial to control wound contracture and reduce the need for commissuroplasty.20

Since a large percentage of electrical injuries involve tort claims against employers, power companies, or manufacturers, the medical record must meticulously detail the history, clinical findings, and treatment.

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