Proposal for new recommendations
Patients who are exposed to low-voltage currents without experiencing an electric shock in the upper body do not need further investigation if they have no or minimal symptoms and normal findings at a general clinical examination (12). Minimal symptoms are defined as, for example, local pain/tenderness, mild paraesthesia, redness of the skin, malaise and lethargy. These are considered to be a temporary reaction to electric shock and do not require interventions or further investigation in the acute phase. Following treatment for any local wounds, these patients can be sent home from the urgent care service, occupational health service or the Emergency Department (13). For more pronounced symptoms, an ECG should be performed.
If the current has passed through a patient's upper body, an ECG should be mandatory. Patients without symptoms or with only minimal symptoms who have no ECG changes do not require to be kept under observation, monitored or hospitalised (14). Troponin and creatine kinase isoenzyme MB (CKMB) are of limited value in the risk assessment of these patients (15). Initial assessment can be carried out by the urgent care service, or a GP or company doctor.
If new ECG changes are found and/or the patient has more than the minimum symptoms, blood sampling, a urine dipstick test, further monitoring and observation should be performed. After 4–6 hours of observation, asymptomatic patients with normal test results and unchanged ECG findings can be sent home (Figure 1) (13, 16). In the event of persistent abnormalities, development of dynamic ECG changes or symptoms that suggest cardiac impact, patients should be further monitored and undergo cardiological examination. In cases of anamnestic suspicion of severe cardiac impact, heart disease or other special circumstances (Figure 1), it is recommended that the patient be referred to hospital for observation, monitoring and possible further examination (17). Pregnant women should have an obstetric consultation (13).
It is important to document muscle and nerve effects in all patients. Such documentation can have implications for treatment, entitlement to welfare benefits and compensation
It is important to document muscle and nerve effects in all patients. Such documentation can have implications for treatment, entitlement to welfare benefits and compensation. Where there are obvious signs of nerve damage, such as paresis, a neurologist should be consulted in the acute phase. Some tingling and slight paraesthesia are common in the initial phase. Symptoms that last longer than a few days should be followed up by a GP (18). Sequelae may also occur after exposure.
The development of rhabdomyolysis has been described in cases of low-voltage electric shock (19), but other studies have not shown rhabdomyolysis that requires treatment (15). If muscle damage is suspected, the patient needs to be referred to the Emergency Department for further examination, including a urine dipstick (haematuria) and CK test. The time of the accident must be recorded for this reason (19). Muscle damage and abnormalities in urine samples or blood tests (CK) are consistent with rhabdomyolysis.