Low voltage (<1000 V) (**Household current** (110/220 V) — cardiac arrhythmia risk (often transient); **oral burns** in toddlers biting cords; **deep tissue injury** may exceed skin findings; fall trauma if thrown from ladder (AAP, ABA, ERC))
Initial assessment priorities (**Scene safety** — power off before contact · **ABCDE** · entry/exit wounds · burn extent · fall trauma · tetanus · neurovascular exam of limbs · **oral commissure burns** — delayed labial artery hemorrhage days later, flexion contracture risk (AAP, ABA, WHO))
First-line therapy
ABCDE + ECG + cardiac observation • procedure
Duration: ED observation · ECG for all significant exposures; **asymptomatic low-voltage brief contact** — ECG still recommended in pediatrics; observe **4–24 h** per AAP/ABA conservative guidance if normal ECG (ABA, AAP, ERC)
• **Scene safety:** ensure power source disconnected before patient contact — do not become second victim; remove source of current if safe (ABA, ERC, WHO).
• **ABCDE:** airway with C-spine if fall; breathing; circulation with entry/exit wound assessment; disability (GCS, neuro exam); exposure — full skin survey, document current path (hand-to-hand, hand-to-foot, oral).
• **ECG indications:** all significant exposures — household **≥110/220 V**, high voltage, lightning, syncope, chest pain, palpitations, abnormal exam; **asymptomatic brief low-voltage** — obtain ECG in children; document evidence-based shared decision if observation shortened (AAP, ABA, ERC).
• **Cardiac monitoring:** continuous **24–48 h** if abnormal ECG, arrhythmia, syncope, high voltage, lightning, or current path through thorax; **asymptomatic normal ECG** after low-voltage household — observation **4–24 h** with serial ECGs per institutional/AAP conservative protocol (ABA, AAP).
• **Labs:** **not routine** for brief asymptomatic low-voltage with normal exam and ECG — obtain CK/myoglobin, renal function, electrolytes, urinalysis only if high-voltage concern, muscle pain, dark urine, or significant burns (ABA, AAP).
Paracetamol • p.o. • 10–15 mg/kg/dose • 4×/day
Max 1000 mg/dose · Max 4000 mg/day · Duration: PRN · 10–15 mg/kg/dose q4–6 h PRN — max 60 mg/kg/day or 4 g/day (whichever lower) for burn pain (ABA, NICE, WHO)
• **Discharge criteria:** asymptomatic; normal serial ECGs; completed observation per protocol; minor low-voltage brief exposure; normal exam; reliable caregivers and return precautions understood (AAP, ABA).
• **Burn management:** cool thermal component with running water — **do NOT apply ice** to electrical burns; non-adherent dressings; early surgical consult for full-thickness, circumferential, or **oral commissure** burns (ABA, WHO).
• **Tetanus:** assess immunization status — Tdap/Td booster if indicated; TIG for tetanus-prone wound with incomplete primary series (AAP Red Book, WHO).
• Low voltage (<1000 V): household current — arrhythmia risk, oral cord bites in toddlers, deep tissue injury may exceed skin findings; assess fall trauma (AAP, ABA).
• ECG: obtain for all significant exposures; in pediatrics ECG often recommended even for brief asymptomatic low-voltage — document approach (AAP, ABA, ERC).
• Observation: asymptomatic + normal ECG after household low-voltage — conservative pediatric observation 4–24 h with serial ECGs per AAP/ABA; admit if abnormal ECG, syncope, or unreliable follow-up.
• Burns: cool running water for thermal component — no ice; oral commissure burns need surgical follow-up and delayed bleeding warning (ABA, WHO).
• Discharge: asymptomatic, normal serial ECGs, completed observation, reliable caregivers; return precautions for arrhythmia, oral bleeding, rhabdomyolysis signs (AAP, ABA).
• AAP — Pediatric electrical and lightning injuries (2024)
• ABA — Electrical burn assessment and referral (2024)
• ERC — Paediatric life support (electrical safety, CPR) (2021)
+ 2 more
• WHO — Burns and electrical injury first aid (2024)
• American Burn Association — Advanced burn life support (electrical burns) (2024)
