Electrical Injury — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] High-voltage / abnormal ECG / myoglobinuria
   High-voltage / abnormal ECG / arrhythmia / myoglobinuria? (Current through tissue → arrhythmia (VF/VT/asystole), neurological (loss of consciousness/apnea/seizure), tetanic muscle contraction causing fractures/dislocations, deep tissue necrosis (often worse than the skin appearance), vascular thrombosis → edema → compartment syndrome, rhabdomyolysis → myoglobinuria → AKI; high-voltage (≥1000 V) is severe, lightning is usually superficial. Assess: ECG in everyone; check CK/urine myoglobin/renal function/troponin; check for compartment syndrome/concomitant trauma.)
   • High-voltage / abnormal ECG / arrhythmia / myoglobinuria / significant burns → High-voltage/abnormal → monitoring + fluids
   • Low-voltage, asymptomatic, normal ECG → Low-voltage asymptomatic · may discharge
2. [End] Low-voltage asymptomatic · may discharge
   Low-voltage, asymptomatic, normal ECG, no loss of consciousness, normal exam (no burns/contact wounds): no prolonged monitoring needed, may be discharged + follow-up. Re-attend for symptoms/arrhythmia/tea-colored urine.
3. [End] High-voltage/abnormal → monitoring + fluids
   High-voltage injury / abnormal ECG / arrhythmia / myoglobinuria / significant burns: admit + continuous ECG monitoring (≥24 h, high-voltage up to 48 h after the last arrhythmia); ABCs/ACLS (arrest may warrant prolonged resuscitation); aggressive fluids for rhabdomyolysis (target urine output ~1.5–2 mL/kg/h, standard burn formulas underestimate) ± urine alkalinization/mannitol; check and manage compartment syndrome (fasciotomy)/escharotomy/debride necrotic muscle; transfer significant/high-voltage injuries to a burn center; tetanus prophylaxis, analgesia.

Source guidelines & references

• Electrical injury (UpToDate; Merck Manual; StatPearls)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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