Electrical Injuries; Roadside to Resus

Electrical injuries present a broad clinical spectrum, requiring a systematic approach that balances trauma assessment with cardiac monitoring. Pathophysiological damage is governed by Ohm’s and Joule’s laws, where current, resistance, and duration determine the extent of tissue necrosis and cardiac disruption. Scene safety remains paramount; high-voltage incidents demand strict isolation protocols and a five-meter safety buffer to prevent rescuer injury. Clinical management centers on the ABCDE framework, identifying occult trauma and potential arrhythmias. While low-voltage shocks with normal ECGs and no symptoms may be safely discharged, high-voltage exposures necessitate 24-hour observation, renal function monitoring for myoglobinuria, and specialized fluid resuscitation for deep-tissue burns. Lightning strikes, though rare, require unique consideration for simultaneous cardiac and respiratory arrest, often necessitating reverse triage in mass casualty scenarios to prioritize patients requiring immediate ventilatory support.