Electric Shock (Causes, Treatment, After Effects)

How Does Electric Shock and Lightning Work?

  • An electric shock occurs when a person comes into contact with an electrical energy source.
  • Electrical energy flows through a portion of the body causing a shock.
  • Exposure to electrical energy may result in no injury at all or may result in devastating damage or death.
  • Many people get electric shocks obtained from man-made objects such as electrical appliances, electrical wires, and electrical circuitry.
  • In addition, lightning strikes are a natural form of electric shock.
  • Burns are the most common injury from electric shock and lightning strikes.

What Causes Electric Shock?

Children, adolescents, and adults are prone to high voltage shock caused by mischievous exploration, exposure at work, to man-made electrical items. About 1,000 people in the United States die each year as a result of electrocution (death caused by electric shock), which is far more than deaths caused by lightning. Most of these deaths are related to on-the-job injuries.

Many variables determine what injuries may occur, if any. These variables include the type of current (AC [alternating current] or DC [direct current]), the amount of current (determined by the voltage of the source and the resistance of the tissues involved), and the pathway the electricity takes through the body.

Low voltage electricity (less than 500 volts) does not normally cause significant injury to humans. Exposure to high voltage electricity (greater than 500 volts) has the potential to result in serious tissue damage. Serious electrical shock injuries usually have an entrance and exit site on the body because the individual becomes part of the electrical circuit.

If a person is going to help someone who has sustained a high voltage shock, he or she needs to be very careful not to become a second victim of a similar electrical shock. If a high voltage line has fallen to the ground, there may be a circle of current spreading out from the tip of the line, especially if the earth is wet or if the voltage line contacts water. The best and safest action is to call 911 or activate the emergency response system in your area. The electric company will be notified so the power can be shut off. A victim who has fallen from a height or sustained a severe shock causing multiple injuries may have a serious neck injury and should not be moved until emergency medical personnel arrive.

Children are prone to shock by the low voltage (110-220 volts) found in typical household current. In children aged 12 years and younger, household appliances, electrical cords, and extension cords caused more than 63% of injuries in one study. Wall outlets were responsible for about 15% of injuries.

Lightning injuries occur infrequently, but cause an average of 47 deaths per year in the U.S. Although there are about 8 million lightning strikes per day on earth, few people are struck and/or killed. Lightning is an environmental form of electric shock that may or may not show external burns, but lightning can injure or kill due to cardiac or respiratory arrest. Neurologic injury is common in individuals struck by lightning. Other injuries are due to severe muscle contractions triggered by the electricity. Indirect injuries caused by lightning strikes can occur with trauma from explosive forces (for example, tree sap and fluid being superheated and trees blown apart due to steam pressure generated when lightning heats up tree sap) or from the electrical charge from lightning dissipated through water and/or the earth.

Flash injuries occur when electrical energy only travels to the skin; indirect injuries caused by man – made electrical devices and lightning strikes may be caused by flame due to clothing catching on fire.

What Are the Symptoms of Electric Shock?

A person who has suffered an electric shock may have very little external evidence of injury or may have obvious severe burns. Some people may be in cardiac arrest after electric shock or a lightning strike.

  • Burns are usually most severe at the points of contact with the electrical source and the ground. The hands, heels, and head are common points of contact.
  • In addition to burns, other injuries are possible if the person has been thrown clear of the electrical source by forceful muscular contraction. Consideration should be given to the possibility of a spinal injury. The person may have internal injuries especially if he or she is experiencing shortness of breath, chest pain, or abdominal pain.
  • Pain in a hand or foot or a deformity of a part of the body may indicate a possible broken bone resulting from the electric shock causing violent muscle contraction.
  • In children, the typical electrical mouth burn from biting an electric cord appears as a burn on the lip. The area has a red or dark, charred appearance.
  • Affected individuals should be examined for entry and exit marks to help determine the extent of the electric shock (for example, a burn on the right-hand may mark the entrance point of electric shock while another usually less - intense burn on the elbow shows circuit electricity traveled - from the hand to the elbow).
  • Some individuals may suffer a cardiac arrest after electric shock (they may not have a pulse or be breathing).

Symptoms of an Electrical Injury

Electrical shock or injury can feel like a slight sensation, or it may lead to immediate cardiac arrest and death. Other symptoms of an electrical injury are second degree burns on the skin, confusion, weakness, and hearing loss.

When to Call 911 for Electric Sock

For high-voltage shocks (over 500 volts or a lightning strike) call 911. If you or the patient is unsure of the voltage exposure, seek medical care.

Following a low-voltage shock, call the doctor or go to an emergency room for the following reasons:

  • If it has been more than 5 years since the affected person's last tetanus booster
  • Burns that are not healing well
  • Burns with increasing redness, soreness, or drainage
  • Any electric shock if a woman is more than 20 weeks' pregnant
  • Any noticeable burn to the skin
  • Any period of unconsciousness
  • Any numbness, tingling, paralysis, vision, hearing, or speech problems
  • Any other worrisome symptoms or signs

What Tests Are Used for Electric Shock Diagnosis?

At the emergency department, the doctor's primary concern is to determine if significant unseen injury exists. Injury may occur to muscles, the heart, or the brain from the electricity or to any bones or other organs from being thrown or burned from the electric source.

The doctor may order various tests depending on the history and physical examination. Tests may include any or none of the following:

Can Electric Shock be Treated at Home?

Brief low-voltage shocks that do not result in any symptoms or burns of the skin do not usually require medical care (if you or the affected individual are unsure about symptoms, seek medical care). For any high-voltage shock, or for any shock resulting in burns, call 911 and seek medical care at a hospital's emergency department. A doctor should evaluate electric cord burns to the mouth of a child.

What Is the Medical Treatment for Electric Shock?

Treatment of electric shock depends on the severity of the burns or the nature of other injuries found.

  • Burns are treated according to severity.
    • Minor burns may be treated with topical antibiotic ointment and dressings.
    • More severe burns may require surgery to clean the wounds or even skin grafting.
    • Severe burns on the arms, legs, or hands may require surgery to remove damaged muscle or even amputation.
  • Other injuries may require treatment.
    • Eye injuries may require examination and treatment by an ophthalmologist, an eye specialist.
    • Broken bones require splinting, casting, or surgery to stabilize the bones.
    • Internal injuries may require observation or surgery.

How Can Electric Shock and Lightning Strike be Prevented?

Steps to prevent electrical injury depend primarily on the age of people involved.

  • For children younger than 12 years, most electrical injuries are caused by power cords. Inspect your power cords and extension cords. Replace any cords that have broken or cracked external covering and any cord that has exposed wire.
    • Do not allow children to play with any electrical cord.
    • Limit use of extension cords and be sure the cord is rated for the current (measured in amps) that will be drawn by the device being powered.
    • Use outlet covers to protect infants from exploring electrical outlets.
    • Update old, ungrounded electrical outlets to grounded (3-prong) systems. Replace outlets near any water (sink, tub) with fused (GFCI) outlets.
  • In children older than 12 years, most electrical injuries result from exploring and activities around high-power systems. Explain to adolescent children that they should not climb on power towers, play near transformer systems, or explore electrified train rails or other electrical systems.
  • Among adults, use of common sense can help reduce electrical injury. People who work with electricity should always check that the power is off before working on electrical systems. Avoid use of any electrical device near water. Be careful and do not stand in water when working with electricity.
  • Use caution when outdoors during a thunderstorm with lightning. Protect yourself from lightning strikes by seeking shelter in a sturdy building or crouching low and stay away from trees and metal objects (golf clubs, metal baseball bats) if caught outdoors. If you are fishing, swimming, surfing or standing in water, get out of the water immediately and seek appropriate shelter.
  • Sometimes weather conditions change rapidly; what may seem like a normal day or a simple rain shower may suddenly produce a lightning strike. For example, a lightning strike in August 2014 occurred in California (Venice Beach), killing one person and shocking 12 others on the beach or in the water. That same day, a golfer on nearby Catalina Island was struck by lightning and hospitalized.
  • Although lightning strikes may occur at any time, they are most frequent in the US usually in July with about 2/3 of strikes occurring between noon and 6 pm according to CDC statistics; Florida is the current "lightning capital" of the US.

What Is the Prognosis for Electric Shock?

Recovery from electric shock depends on the nature and severity of the injuries. The percentage of the body surface area burned is the most important factor affecting prognosis.

If someone who has received an electric shock does not suffer immediate cardiac arrest and does not have severe burns, he or she is likely to survive.

Infection is the most common cause of death in people hospitalized following electrical injury.

Electrical damage to the brain may result in a permanent seizure disorder, depression, anxiety, or other personality changes.

What Does Electric Shock Look Like (Pictures)?

Electric shock, contact injury to hand. Photograph by Timothy G. Price, MD.
Electric shock, contact injury to hand. Photograph by Timothy G. Price, MD. Click to view larger image.

Electric shock burns due to current flow through metal framed glasses. Photograph by Timothy G. Price, MD.
Electric shock burns due to current flow through metal framed glasses. Photograph by Timothy G. Price, MD. Click to view larger image.

Electric shock injury to the foot. Photograph courtesy of William Smock, MD.
Electric shock injury to the foot. Photograph courtesy of William Smock, MD. Click to view larger image.

Electric shock injury to the hand. Photograph courtesy of William Smock, MD.
Electric shock injury to the hand. Photograph courtesy of William Smock, MD. Click to view larger image.

Reviewed on 5/16/2018

Medically reviewed by Joseph Palermo, MD; Board Certificate Internal Medicine/Geriatric Medicine

REFERENCES:

CDC. Lightning.
<https://www.cdc.gov/disasters/lightning/index.html>

Daley, BJ, MD. Electrical Injuries. Medscape. Updated: Feb 08, 2017.
<https://emedicine.medscape.com/article/433682-overview>

The Wall Street Journal. One Killed, 12 Injured in California Lightning Strikes.

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