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Which of the following patients that sustained electrical injury requires further observation in the ED or admission (should not be discharged home now)?
A) A toddler that bit on an electrical cord, has an oral commissure burn, but has normal labs and ECG and is tolerating po’s and has no active bleeding
B) A 4 year old that put a fork into a European socket and sustained a small burn to the hand, is asymptomatic, has normal CK and ECG and soft compartments
C) A teen who was running from law enforcement and was brought in with a retained taser dart, which has been subsequently removed, and who is currently asymptomatic
D) A teen who touched a downed power line and sustained electrical shock, labs and ECG are normal and is currently asymptomatic
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December 22, 2017 at 4:57 am
The answer is D. The toddler with the oral commissure burn is at risk of the eschar falling off and having a labial artery bleed, but not until 1-2 weeks later, so should be discharged with good education for the parents as to what to look for and how to manage this complication. The 4 year old has sustained a low voltage electrical injury, is asymptomatic and has a normal ECG and CK, so can go home. Household current is 110V in the USA, and often 220 V in Europe. However, voltage is not considered high voltage until 1000V. Taser darts do not result in significant complications from an electrical injury perspective. The teen that touched a downed power line, however, sustained a high voltage exposure, and even if the patient is asymptomatic, should be observed on cardiac monitoring for 12-24 hours. Check out the PEM Playbook podcast on electrical injuries at http://pemplaybook.org/podcast/electrical-injuries-hertz-so-bad/