EM Coach: Shock to the System

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A 30-year-old female presents to the emergency department complaining of an electric shock to her hand from a household outlet while doing electrical work on her home.

She reports no symptoms and has a normal physical exam. Her electrocardiogram is as shown.


2022-07_EPM_stem image

Which of the following is the most appropriate next step in management?

A. Admission to the hospital for cardiac monitoring
B. Discharge home
C. Observation in the emergency department for at least six hours
D. Obtain creatine kinase level
E. Obtain potassium level


Correct answer:

B. Discharge home
Low voltage injuries <600 V are commonly caused by home outlets. In the United States, outlets are 120 V, while in Europe and Australia they are 240 V. The electrocardiogram shown is normal. Asymptomatic patients with normal ECGs on arrival to the hospital can be safely discharged from the ED.

Incorrect answer choices:

Cardiac monitoring (Choice A) and ED observation (Choice C) are not required for asymptomatic patients with a normal ECG after a low voltage electrical injury. Patients who feel unwell or have any new ECG abnormality should be monitored for six hours and reassessed.

Laboratory testing (Choices D and E) and imaging are usually not required unless the patient is symptomatic or has abnormal physical examination findings. Patients with criteria in the below table should be admitted for electrocardiographic monitoring following electrical injury.

2022-07_EPM_explanation table



Gentges, J, Schieche, C. Electrical Injuries in the Emergency Department: An Evidence-Based Review. EB Medicine. November 1, 2018. Accessed June 15, 2022. https://www.ebmedicine.net/topics/burns/electric-shock-burns (full free access for residents)

Bailey C. Chapter 218. Electrical and Lightning Injuries. In: Tintinalli JE, Stapczynski JS, Ma OJ, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York: McGraw Hill Professional; 2016.

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