Electric shock in the pediatric population
Electric shock is a form of trauma and affects both the adult and pediatric populations at a rate of approximately 20%.
In the pediatric population, electric shock occurs mainly at home and mostly affects infants and preschool children, with boys being twice as likely as girls.
Sockets, cables and small electrical appliances are the main sources. Especially in the infant population, the cause is often chewing on cables, which can be particularly dangerous due to late bleeding from the burn caused in the infant’s oral cavity.
The effect of electricity on tissues and the heart occurs either directly and causes arrhythmias and respiratory arrest, or through the conversion of electrical energy into heat and causes burns, or through direct cell lysis and cell death or through mechanical trauma following electric shock with high voltage current.
The amount and intensity of the current, the type (alternating or direct), the duration of exposure, the surface area of the body exposed, the resistance of the tissues (which is lower when the skin is wet) and the path through the body also determine the extent of the damage. As for household electrical current (low voltage alternating), more than 16mA can cause involuntary muscle contraction in the hand and thus does not allow the victim to remove himself from the electrical source, extending the duration of exposure.
Electric shock can cause anything from a simple superficial skin discomfort to serious complications requiring hospitalization in an intensive care unit or even death.
Electric shock in children in the home environment is usually of low intensity and rarely leads to serious injuries.
When assessing the patient, we need to know details about the source and duration of contact. The trauma that has been caused may indicate a path through the chest if the entrance and exit are in both arms. Patients with electric shock from household current may not have any damage. However, if there is prolonged exposure, they may even experience cardiorespiratory arrest.
High-voltage electric shock usually leads to very serious complications and/or death.
All patients, regardless of their symptoms and the extent of skin damage, which in high-voltage electric shock is not necessarily related to the extent and severity of internal damage, should undergo a thorough evaluation.
As long as there is no significant traumatic injury or disturbance in cardiac function on initial assessment, it is unlikely to occur after 24 hours.
Therefore, in general, children who have been electrocuted with low-voltage household current, without a history of heart disease, who are asymptomatic and provided that the clinical evaluation and initial electrocardiogram are normal (including the absence of entry and exit points or burns) can return home after the initial evaluation.
In the case of patients with low-voltage electric shock and limited skin lesions, cardiac monitoring is required for several hours.
Cardiac monitoring is required for all patients who present to the emergency department with more than a low-voltage electric shock, especially if there is a history of heart disease, chest pain, or an abnormal electrocardiogram upon admission.
Most rhythm disturbances occur in 15% of patients, they are usually benign such as sinus tachycardia, atrial fibrillation, and ventricular arrhythmias, but they can also be potentially life-threatening (ventricular fibrillation). While they usually occur in the first hours after the event, especially if the current has passed through the chest, monitoring is extended accordingly from 12-24 hours.
The long-term prognosis of patients depends on the severity of the electric shock and the occurrence of complications, while measures to protect the pediatric population from electric shock in the home environment, namely covering sockets and cables as well as the use of electrical appliances based on instructions by older children, contribute to avoiding accidents.
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