Electrical shock and its management

Ashah K1*, Shalini H S2, Vijayakumari. D3

1Nursing Incharge, CNO2, Kauvery Hospital, Electronic city, Bangalore

2Chief Nursing Officer, Kauvery Hospital, Electronic city, Bangalore

3Nursing Educator, Kauvery Hospital, Electronic city, Bangalore

*Correspondence

Abstract

The World Health Organization (WHO) and other international medical standards define electric shock as the physiological effect resulting from electric current passing through the human body. While specific “introductory” guidelines often focus on clinical management, the core definition centers on the interaction between electrical energy and biological tissue.

Electrical shock, the perceptible and physical effect of an electrical current that enters the body. The shock may range from an unpleasant but harmless jolt of static electricity, received after one has walked over a thick carpet on a dry day, to a lethal discharge from a power line.

Electric shock occurs when a person becomes part of an electrical circuit, allowing current to flow through the body. Key causes include touching exposed wiring, faulty or damaged appliances, water contact with electronics, damaged power cords, overloaded sockets, downed power lines, and lightning strikes.

Key words: World Health Organization (WHO); Electric shock

Introduction

An electric shock is a sudden, painful, or harmful physiological response occurring when an electric current passes through the body upon contact with a live electrical source. It acts as a conductor, leading to involuntary muscle spasms, burns, cardiac arrhythmia, or death. Severity depends on amperage, voltage, and duration.

 

Causes of Electric Shock

    • Faulty/Damaged Appliances and Cords: Frayed electrical cords, damaged insulation, or poorly functioning appliances can expose live wires.
  • Water and Electricity: Using electrical devices with wet hands or in wet areas (e.g., bathrooms, kitchens, outdoors) significantly increases risk because water is a conductor.
  • Exposed Household Wiring: Improperly installed or degraded wiring, as well as reaching   into electrical outlets (particularly by children), can cause shocks.
  • Overloaded Outlets: Plugging too many devices into a single outlet or extension cord can overheat, damage the outlet, and cause shock.
  • Power Lines and External Sources: Contact with downed power lines or heavy electrical machinery.
  • Lightning Strikes: Direct or nearby lightning strikes can deliver fatal high-voltage shocks.
  • Occupational Hazards: Improper lockout/ tag out procedures (not isolating circuits), working on live equipment, and lack of training.
  • Static Electricity: The sudden buildup and discharge of electricity between objects or people, often caused by friction (e.g., walking on carpet in dry air).

Factors Influencing Shock Severity

  • Amount of Voltage: High voltage (typically >500-600 volts) causes more severe damage than low voltage.
  • Current Pathway: If the current passes through the heart or brain, it is more dangerous.
  • Resistance: Dry skin provides higher resistance, while wet skin provides lower resistance, allowing more current to pass.
  • Duration: The longer the contact with the source, the more severe the injury.

Signs and Symptoms of Electrical Shock

Electric shock occurs when a person becomes part of an electrical circuit, with symptoms ranging from mild tingling to instant fatality. Symptoms depend on the voltage, duration, and path of the current through the body.

Immediate and Common Symptoms

  • Muscle Spasms and Pain: Intense contractions, often preventing the person from “letting go” of the source.
  • Burns: Typically found where the electricity entered and exited the body (often hands, feet, or head).
  • Numbness or Tingling: Paresthesia (a pins-and-needles sensation).
  • Headache: Often described as an intense, brief pain.
  • Dizziness or Fainting: Lightheadedness or loss of consciousness.
  • Heart Irregularities: Weak, rapid, or irregular pulse (arrhythmia s).

Severe Symptoms

  • Cardiac Arrest: The heart stops beating properly.
  • Respiratory Arrest: Breathing stops or becomes very difficult.
  • Seizures: Violent involuntary movements.
  • Unconsciousness: Coma or failure to respond.
  • Broken Bones or Dislocations: Caused by violent muscle spasms or being thrown by the shock.
  • Mental Changes: Confusion, agitation, memory loss, or panic.

Long-Term Symptoms

  • Compartment Syndrome: Swelling in limbs that compresses arteries and damages muscles.
  • Neurological Damage: Persistent tingling, weakness, or paralysis.
  • Cataracts: Eye damage that can develop months or years later.
  • Psychological Issues: Anxiety, depression, or PTSD (often called Post Electric Shock Syndrome).

Main Types of Electrical Injuries

  • True High-Voltage/Low-Voltage Contact: The person becomes part of the electrical circuit, with current entering and exiting the body, causing internal and external tissue damage.
  • Arc Flash/Flash Burns: High-temperature electrical explosions that jump through the air, causing severe superficial burns, eye damage (UV/IR light), and, rarely, current conduction.
  • Flame Injury: An arc flash ignites a person’s clothing, causing thermal burns that may be separate from the electrical damage.
  • Lightning Injury: Extremely high-voltage, short-duration injury where current often flashes over the skin surface rather than through the body.
  • Secondary Injuries: Physical harm caused indirectly by the shock, such as falling from a ladder, muscle spasm, or jumping away from a live wire.

Complications

High electrical field strength often causes electro chemical or thermal damage to affected tissues, increasing the risk of protein coagulation, coagulation necrosis, hemolysis, thrombosis, muscle or tendon avulsion, and dehydration. Beyond the direct electrical injury, it can also lead to massive tissue edema, resulting from thrombosis, vascular congestion, and muscle swelling, which may progress to compartment syndrome. This tissue edema can cause dehydration, accompanied by hypovolemia and hypotension. Severe muscle injury may trigger rhabdomyolysis, myoglobinuria, and electrolyte imbalances. Collectively, these complications place patients at a very high risk for acute kidney injury.

Immediate and Acute Complications

  • Cardiovascular: Ventricular fibrillation, cardiac arrest, arrhythmias, and hypertension.
  • Neurological: Seizures, coma, confusion, and loss of consciousness.
  • Physical/Tissue: Deep electrical burns at contact points (entry/exit), severe muscle spasms, and injuries from falls (e.g., fractures).
  • Respiratory: Respiratory arrest, where the patient stops breathing

Long-Term and Chronic Complications

  • Neurological: Nerve damage, tingling, numbness, chronic pain, motor deficits, and epilepsy.
  • Psychological: PTSD, anxiety, depression, and memory loss.
  • Cognitive: Difficulty concentrating and reduced verbal recall.
  • Vision/Hearing: Cataracts (sometimes developing years later) and tinnitus.
  • Musculoskeletal: Chronic pain, fatigue, limited mobility, and muscle contractures

Case Presentation

Patient brought to ER in unresponsive state with alleged history of Accidental Electrical Injury at workplace on road near SKF Building, Konappana Agrahara road, Electronic city Bangalore at ~ 9.30 am on 17.10.2025. Informant is wife of the patient.

Clinical Examination

On arrival.

Average built32 years / Male.
Temp 97.1°F.
GRBS66mg/dl
Respiratory SystemNo chest rise.
CVSNo heart sounds heart. ECG: Flat rhythm. No pulse felt (central)
Central Nervous SystemDilated, fixed 3.5mm

Course in the Hospital

32-year-old male was admitted with above mentioned complaints. On arrival to the ER he was unresponsive with absent vital signs. CPR initiated as ACLS protocol. Patient intubated in view of shock. VBG showed Metabolic Acidosis He was admitted to ICU for further management, patient had Hypotension for which Nor-adrenaline infusion was started. Relevant lab investigations were done CBC showed Haemoglobin 13.1g/dl, PCV – 39.6%, TLC – 8410 Cells/cu.mm, PC – 198000 cells/cu.mm, sodium 139 mmol/L, Potassium 3.0, chloride 112 mmol/L, creatinine 0.8 mg/dL. 2D Echo showed Normal chamber dimensions, MR-Grade I, TR – Mild with mild PAH (PASP -43mmHg), Global hypokinesia of LV, Severe LV Systolic Dysfunction, LVEF – 30%. In view of cardiogenic shock EF showed 30% cardiologist opinion was sought and advice followed. Patients were treated with IV fluids, antibiotics, steroids, antacids, analgesics and other supportive measures. Left palm showed signs of electrocution burns (superficial), no exit wound noticed. In view of OHCA witnessed (by wife) who gave CPR and accompanied the patient to hospital giving CPR. Patients were subjected to hypothesis protocol (T.T.M) Management to prevent Hypoxic brain injury (Targeted Temperature Management) was done for 48 hours to temperatures of 32°C and gradually rewarmed after 48hours to room temperature. Bronchoscopic lavage was done at admission to clear all secretions. Fluids were titrated to urine output / cardiogenic shock and prevention of hypovolemia and prevention of AKI. Neurologically, shivering (vs) seizures were contemplated. The patient showed clinical improvement by day 3, and after normalizing temperature with GCS of E4V5M6 after extubation on 19.10.2025. Echo repeat was normal and the patient was shifted to ward. Reviewed by neurology and cardiology team on 21.10.2025. Suggested MRI Brain and spine, EEG, ECG and Echo and investigations at discharge. Patient is ambulant, taking orally. Has retrograded amnesia to the event that occurred on 17.10.2025. Patient and attenders were counseled regarding Neurological treatment; His ward stay was uneventful hence patient got discharged.

Emergency First Aid Steps (First 5 Minutes)

  • Do Not Touch: Never directly touch someone who is still in contact with the electrical current.
  • Turn Off Power: Switch off the power at the circuit breaker, fuse box, or unplug the appliance if safe.
  • Separate from Source: If power cannot be turned off, use a dry, nonconductive object such as a wooden broom handle, plastic chair, or dry cloth to move the person away from the source.
  • Call emergency services: Call immediately, especially if the shock is high-voltage (e.g., downed power lines) or if the person is unconscious.
  • Check Breathing/Pulse: If the person is not breathing or has no pulse, begin CPR immediately.
  • Recovery Position: If the person is breathing but unconscious, place them in the recovery position.

Discussion

Upon arrival in the emergency department, patients with electrical injuries should be promptly stabilized and provided with respiratory and circulatory support as needed, following Advanced Cardiovascular Life Support (ACLS) and Advanced Trauma Life Support (ATLS) protocols. Cardiac monitoring should be initiated in all patients who have sustained more than a minor low-voltage electrical burn.

Any patient presenting with facial or oral burns, hypoxia, respiratory distress, loss of consciousness, or any condition that compromises airway protection or patency should receive supplemental oxygen and appropriate airway management, such as ventilation, intubation, or cricothyrotomy. Depending on the type of trauma or injury sustained, the patient may require cervical spine or full spinal immobilization. A primary assessment to evaluate traumatic injuries (eg, pneumothorax or fractures) should be performed promptly. Following this, any patient with significant burns or suspected rhabdomyolysis (evidenced by myoglobinuria) should receive fluid resuscitation, with a target urine output of 1 to 2 ml/kg/h. The use of an osmotic diuretic (eg. mannitol), a loop diuretic (eg, furosemide), or urine alkalinization (via sodium bicarbonate titration) may be considered. However, such interventions are generally discouraged in patients with cutaneous burns involving more than 20% of the total body surface area or those with concomitant trauma, as these individuals may be hypovolemic and at risk for hemodynamic instability.

Intravenous (IV) access should be established in all adult patients who have experienced an electrical injury. If IV access proves difficult, intraosseous (IO) access should be considered. In cases of significant trauma, cardiac or respiratory arrest, or loss of consciousness, central IV access may be necessary. Whenever possible, IVs, IOs, and central lines should not be placed through burned tissue, as this increases the risk of infection. However, if no alternative access sites are available, these lines may be used temporarily, as prompt resuscitation takes priority. Proper burn care should be initiated, including administering a tetanus vaccination if needed, along with appropriate splinting and bandaging after a thorough neurovascular assessment.

Any patient who has experienced cardiac or respiratory arrest, loss of consciousness, chest pain, hypoxia, arrhythmia, significant trauma or burns, or show abnormalities on ECG should be admitted for further inpatient care. This may also be followed by transfer to a burn care unit or a rehabilitation center as necessary. Finally, early consultations with trauma or critical care specialists, surgical teams, and orthopedic specialists should be initiated to help prevent complications and minimize the risk of irreversible damage. Before discharge, patients should receive education on potential sources of electrical exposure at home and in the workplace, along with information about the possible long-term effects of electrical injuries, including neurological, psychological, or physical complications. Appropriate follow-up appointments should also be scheduled based on the severity and nature of the injury.

Evaluation

Electrical injuries affected individuals should be addressed as both trauma and cardiac patients. All adult patients who have experienced an electrical injury should undergo an electrocardiogram (ECG) and cardiac monitoring. Prolonged monitoring is warranted for patients presenting with chest pain, ECG abnormalities, a known transthoracic pathway of electrical injury, cardiac arrest, loss of consciousness, or preexisting cardiac history. Most patients without significant injury or cardiac abnormalities on initial assessment are unlikely to develop any cardiac abnormalities after 24 to 48 hours.

In general, patients with a normal ECG who have sustained a low-voltage electrical injury, without any cardiac symptoms or a history of cardiac issues, may be safely discharged from the hospital after a thorough physical examination. Similarly, children exposed to low-voltage, household current electrical exposure without any significant injury or preexisting cardiac history may be discharged following a comprehensive physical examination. Laboratory studies to be considered for any patient who has experienced an electrical injury include a complete blood count (CBC), a comprehensive metabolic panel with evaluation of electrolytes and creatinine levels, and urinalysis. If myoglobinuria is detected on urinalysis, serum myoglobin should be assessed. An arterial blood gas analysis may be warranted in patients with rhabdomyolysis or those requiring respiratory support. Creatine kinese (CK) levels should be evaluated, particularly if rhabdomyolysis is suspected. If the electrical current is suspected to have passed through the chest, or if the patient reports chest pain or has ECG abnormalities (eg, arrhythmia or ischemia), cardiac biomarkers such as CK-MB and troponin should also be measured.

Imaging studies may be considered based on the type of injury and associated symptoms. A chest radiograph is indicated for patients presenting with cardiac or respiratory arrest, chest pain, and shortness of breath, hypoxia, a history of fall or blunt trauma, or those who require cardiopulmonary resuscitation (CPR). A head computed tomography (CT) scan is warranted for patients with altered mental status, known head trauma, loss of consciousness, seizures, or focal neurological deficits. In addition to a head CT scan, cervical spine immobilization is recommended for these patients, and cervical spine imaging may also be considered. However, it may not be necessary in patients without focal neurological deficits, changes in mental status, or significant injury.

Notably, the severity of an electrical injury does not correlate with the extent of external burns on an individual’s body; the absence of visible burns does not rule out internal tissue damage. Therefore, some patients may require additional imaging, such as CT or ultrasound, depending on the suspected path of the electrical current through the body. The choice of imaging modality should be guided by the specific tissues being evaluated. Finally, high-voltage exposure or prolonged contact with low-voltage current may cause significant tissue damage that warrants surgical intervention, such as fasciotomy. In such cases, early surgical consultation is essential, as prompt fasciotomy may help prevent serious complications, including limb amputation.

Conclusion

Diagnosing and managing electrical injuries is most effective with an inter-professional team, including emergency department providers, radiologists, surgeons, trauma specialists, anesthesiologists, and burn specialists. Depending on the injury’s severity, following the advanced trauma life support protocol may be necessary. Cardiac monitoring should be initiated for all patients who have sustained a low-voltage burn, regardless of its severity. Implementing structured treatment algorithms within healthcare institutions has been shown to improve the management of electrical injuries. A study demonstrated that such protocols could reduce unnecessary testing and hospital admissions while effectively identifying patients at risk for complications.

Any patient presenting with facial or oral burns, hypoxia, respiratory distress, loss of consciousness, or difficulty protecting or maintaining a patent airway should receive oxygen and airway protection measures (eg, ventilation, intubation, or cricothyrotomy). All patients who experience respiratory or cardiac arrest require ICU admission. Early consultation with trauma or critical care specialists, surgical specialists, and orthopedists is recommended to prevent complications or irreversible damage.Before discharge, patients should be educated about potential sources of electrical exposure at home and work, the associated risks, and any possible long-term effects of their electrical injuries (eg, neurological, psychological, or physical). Appropriate follow-up should be scheduled as needed.

The outcome and prognosis of electrical injuries depend on the location and extent of the injury, the development of complications, and the patient’s functional recovery. High-voltage electrical injuries are associated with poorer outcomes compared to low-voltage injuries. However, recent advancements in intensive care units (ICUs), resuscitation, nutritional support, surgical techniques, and the use of novel skin substitutes have significantly improved overall outcomes.

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