Browse categories and answer follow-up questions to refine your symptom profile.
History
Mechanism and exposure
Electrical exposure details
Voltage category
Low voltage less than 1000 V
High voltage 1000 V or more
Current type
Alternating current
Direct current
Contact pattern
Hand to hand
Hand to foot
Duration of contact
Wet environment exposure
Lightning strike mechanism
Direct strike
Side flash
Ground current
Contact injury
Timeline and associated events
Event timeline
Time since injury
Witnessed loss of consciousness
Seizure activity
CPR required
Fall or blunt trauma after shock
Symptoms
Presenting symptoms
Chest pain
Palpitations
Dyspnea
Weakness
Paresthesias
Myalgias
Dark urine
Visual changes
Hearing changes
Burns and wounds history
Skin injury history
Entry site location
Exit site location
Thermal burn exposure
Clothing ignition
Baseline and prior episodes
Baseline status and prior events
Prior dysrhythmia history
Cardiac device presence
Prior electrical injury
Alarm Features
Immediate life threats
Resuscitation triggers
Cardiac arrest
Ventricular dysrhythmia
Hemodynamic instability
Airway compromise
Altered mental status
Ongoing seizure
High risk history features
High risk electrical features
High voltage exposure 1000 V or more
Lightning strike
Prolonged contact
Tetany with inability to let go
Suspected transthoracic current path
High risk exam features
High risk findings
Chest wall burns
Extensive burns
Neuro deficits
Compartment syndrome concern
Vascular compromise distal to injury
Vital sign danger thresholds
Vital sign red flags
Hypotension
Persistent tachycardia
Hypoxia
Hyperthermia
Escalation logic
Escalate to resuscitation bay if
Any instability
High voltage exposure with systemic symptoms
Abnormal ECG
Medications
Current meds and interactions
Medication review
QT prolonging agents
Rate control agents
Antiarrhythmics
Diuretics
Insulin and glucose lowering agents
Anticoagulants
Analgesia and sedation considerations
Analgesia plan constraints
Opioid tolerance history
Substance use exposure
Respiratory depressant coingestions
Tetanus prophylaxis status
Tetanus immunization
Last booster date unknown
Incomplete primary series
Diet
Hydration and muscle injury context
Hydration status
Poor oral intake
Dehydration symptoms
Recent heavy exertion
Electrolyte and stimulant exposures
Relevant exposures
Caffeine and energy drinks
Supplements
Creatine use
Review of Systems
Cardiopulmonary
Cardiopulmonary symptoms
Chest pain
Palpitations
Dyspnea
Syncope
Neurologic
Neurologic symptoms
Headache
Confusion
Focal weakness
Sensory loss
Vision change
Hearing change
Musculoskeletal and renal
Muscle and renal symptoms
Myalgias
Limb pain out of proportion
Swelling
Dark urine
Oliguria
Skin and burns
Skin symptoms
Pain at contact points
Blistering
Progressive swelling
Collateral History and Family History
Collateral source
Collateral information
Witness description of event
Timing accuracy and reliability
Scene details
Family history
Relevant family history
Sudden cardiac death
Inherited arrhythmia syndromes
Cardiomyopathy
Risk Factors
Patient factors
Medical risk factors
Structural heart disease
Known dysrhythmias
Chronic kidney disease (N18.9)
Diabetes mellitus (E11.9)
Exposure and occupational factors
Exposure risks
Industrial electrical work
Unsafe work conditions
Water exposure
Lightning activity exposure
Injury pattern risks
Injury risks
Falls from height
Concomitant trauma
Crush injury features
Differential Diagnosis
Life threatening
Life threatening diagnoses
Ventricular tachycardia
Palpitations with syncope
Wide complex rhythm on ECG
Ventricular fibrillation
Collapse
Pulseless arrest
Myocardial ischemia or infarction (I21.9)
Chest pain
Ischemic ECG changes
Respiratory failure
Airway burns
Hypoxia
Compartment syndrome (T79.A0)
Pain out of proportion
Pain with passive stretch
Rhabdomyolysis (M62.82)
Myalgias
Elevated CK
Hyperkalemia (E87.5)
Muscle injury
ECG changes
Common
Common diagnoses
Electrical burn injury (T75.4)
Entry and exit wounds
Deep tissue injury disproportionate to skin findings
Thermal burn injury
Clothing ignition
Contact with hot surfaces
Peripheral nerve injury
Paresthesias
Weakness
Musculoskeletal strain from tetany
Localized pain
Normal neuro exam
Less common
Less common diagnoses
Cataract after electrical injury
Vision changes
Delayed presentation
Tympanic membrane injury
Hearing change
Otalgia
Vascular injury
Pulse deficit
Cool extremity
Spinal cord injury
Neuro deficits
Trauma mechanism
Mimics and pitfalls
Mimics and pitfalls
Primary seizure disorder
Seizure without electrical contact evidence
Postictal features
Primary cardiac syncope
Prodrome absent
Prior syncope history
Past Medical History
Cardiovascular and neurologic
Relevant conditions
Coronary artery disease (I25.10)
Heart failure (I50.9)
Congenital heart disease
Long QT syndrome
Seizure disorder (G40.909)
Renal and metabolic
Renal and metabolic history
Chronic kidney disease (N18.9)
Prior rhabdomyolysis episode
Sickle cell disease (D57.1)
Devices and procedures
Implanted devices and procedures
Pacemaker
ICD
Vascular grafts
Physical Exam
Primary survey focused exam
ABCDE overview
Airway patency
Breathing effort
Circulation perfusion
Disability mental status
Exposure and temperature
General and vitals interpretation
General appearance
Toxic appearance
Diaphoresis
Agitation
Vital signs patterns
Persistent tachycardia
Hypotension trends
Hypoxia
Skin and burns
Skin exam
Entry wound
Exit wound
Circumferential burns
Progressive swelling
Cardiopulmonary
Heart and lungs
Rhythm regularity
New murmur
Crackles
Work of breathing
Neuro and MSK
Neurologic exam
GCS trend
Focal motor deficits
Sensory deficits
Gait if safe
Extremity exam
Tenderness and deformity
Range of motion limits
Compartment firmness
Vascular and compartment checks
Limb perfusion
Distal pulses
Capillary refill
Temperature asymmetry
Compartment syndrome features
Pain out of proportion
Pain with passive stretch
Paresthesias progression
Lab Studies
Core labs for significant exposure
Initial laboratory evaluation
CBC
Electrolytes
Creatinine
Glucose
CK
AST
ALT
Venous blood gas
Rhabdomyolysis and renal injury
Muscle injury assessment
CK trend
Potassium
Calcium
Phosphate
Urinalysis
Heme positive with few RBC
Pigment nephropathy concern
Cardiac labs
Cardiac injury testing
Troponin if chest pain
Troponin if abnormal ECG
Troponin if high voltage exposure with symptoms
Toxicology and coexposure
Coingestion evaluation
Ethanol level if altered
Acetaminophen level if unclear history
Salicylate level if unclear history
Imaging
Scoring Systems
Burn and trauma scoring
Total body surface area percent
Partial thickness burn estimate
Full thickness burn estimate
Revised Baux score
Age plus TBSA percent
Inhalation injury adjustment local protocol dependent
MRI
MRI considerations
Spinal MRI if neuro deficits with normal CT
Soft tissue MRI for deep muscle necrosis if unclear
Contraindications
Non compatible implanted device
Unstable patient
CT
CT evaluation
CT head if loss of consciousness with trauma mechanism
CT cervical spine if trauma criteria met
CT chest abdomen pelvis if high energy fall or multisystem trauma
Contrast cautions
Acute kidney injury concern
Contrast allergy history
Ultrasound
Ultrasound applications
FAST exam if trauma concern
Cardiac POCUS for global function if hypotension
Extremity Doppler if pulse deficit
Compartment related findings
Subfascial edema nonspecific
Clinical diagnosis remains primary
Special Tests
Bedside monitoring and burn depth adjuncts
Bedside tests
Serial neurovascular checks
Serial compartment checks
Continuous pulse oximetry
Temperature monitoring
Specialty evaluations
Specialty assessments
Ophthalmology if vision symptoms
Audiology or ENT if hearing symptoms
Burn service evaluation criteria
Procedural diagnostics
Procedural considerations
Escharotomy indications
Circumferential burn with vascular compromise
Rising compartment concern
Fasciotomy indications
Confirmed compartment syndrome
Neurovascular compromise progression
ECG
Indications and monitoring windows
ECG and telemetry indications
Any loss of consciousness
Chest pain
Palpitations
Abnormal vital signs
High voltage exposure
Lightning strike
Concerning ECG findings
High risk ECG patterns
Ventricular tachycardia
Ventricular fibrillation
New heart block
Ischemic ST changes
QT prolongation
Serial ECG strategy
Serial ECG triggers
Persistent symptoms
Initial abnormalities
Troponin rise
Assessment
Problem representation
Working problem list
Electrical injury (T75.4)
Burn severity category
Trauma from fall mechanism if present
Risk stratification
High risk electrical injury features present
High voltage exposure
Transthoracic path suspicion
Abnormal ECG
Syncope or seizure
Significant burns
Complications to rule out
Key complications
Dysrhythmia
Myocardial injury
Rhabdomyolysis
Acute kidney injury
Compartment syndrome
Occult trauma
Alternative diagnoses
Diagnostic uncertainty considerations
Primary syncope
Primary seizure
Substance intoxication
Plan
Approach to the critical patient
First 5 minutes
Cardiac monitor
Defibrillator pads if unstable
IV access
Two large bore if high risk
IO if no IV and unstable
Oxygen if hypoxia
Immediate ECG if high risk features
Point of care glucose if altered
Burn and wound management
Burn care
Remove smoldering clothing and jewelry
Cool thermal burns with tepid water
Avoid prolonged cooling with hypothermia risk
Cover burns with clean dry dressing
Tetanus prophylaxis per immunization status
Cardiac management
Cardiac monitoring and treatment
Telemetry duration local protocol dependent
ACLS for dysrhythmias
Treat hyperkalemia if present
Calcium gluconate IV 1 g
Insulin regular IV 10 units with dextrose
Nebulized albuterol
Rhabdomyolysis and renal protection
Fluid strategy
Isotonic crystalloid IV bolus if hypovolemia
Ongoing IV fluids titrated to urine output target local protocol dependent
Avoid potassium containing fluids if hyperkalemia
Electrolyte management
Potassium correction
Calcium correction only if symptomatic
Phosphate correction if severe
Pain control
Analgesia
Acetaminophen PO or IV
Opioid IV for severe pain
Avoid NSAIDs if acute kidney injury concern
Consultation and transfer
Consultation plan
Burn center criteria consideration
Surgery or orthopedics if compartment concern
Cardiology if persistent ECG changes
Trauma team if multisystem trauma
Reassessment loop
Reassessment cycle
Repeat vitals every 15 to 30 minutes if high risk
Repeat neurovascular checks every 30 to 60 minutes if limb injury
Repeat pain and swelling assessment after analgesia
Repeat ECG if symptoms change
Disposition
ICU and monitored bed criteria
Higher level of care criteria
Dysrhythmia
Hemodynamic instability
Abnormal ECG requiring monitoring
Significant burns requiring resuscitation
Severe rhabdomyolysis
Hyperkalemia
Compartment syndrome concern
Inpatient admission criteria
Admission indications
High voltage exposure with symptoms
Elevated CK with renal injury risk
Deep tissue injury concern
Concomitant trauma requiring observation
Observation pathway criteria
Observation candidates
Low voltage exposure with transient symptoms
Normal ECG
Normal initial labs when obtained
Reliable follow up
Discharge criteria
Discharge requirements
Low voltage exposure
No syncope
Normal ECG
No significant burns
No concerning trauma findings
Normal neuro exam
Follow up timing
Follow up plan
Primary care within 24 to 72 hours if symptoms
Burn clinic timing based on burn depth
Ophthalmology if vision symptoms develop
Discharge Instructions
Copy discharge instructions
Diagnosis summary
Electrical shock injury with no dangerous heart rhythm found today
Burns are superficial unless told otherwise
Medications
Pain control as directed
Avoid NSAIDs if kidney concerns discussed
Wound care
Keep dressings clean and dry
Return for increasing redness or drainage
Activity
Avoid strenuous activity for 24 hours
No driving if fainted or had seizure like episode
Return to ED now for
Chest pain
Palpitations
Fainting
Trouble breathing
Worsening weakness
New numbness
Severe increasing limb pain
Dark urine
Fever
Follow up
Primary care follow up within 2 to 3 days
Burn clinic follow up if instructed
References
Guidelines and core sources
Core references
American Burn Association burn referral criteria
American Heart Association ACLS guidelines
ATLS guidelines for trauma evaluation
Emergency medicine review articles on electrical and lightning injuries
Source file
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.