Electrical injury can result from direct contact with any source of electricity. While some electrical shocks may result in minor burns, there still may be serious internal damage. Hence, producing a complex pattern of injury and clinical manifestations. The exact pathophysiology of an electrical injury is very difficult to predict due to the large number of variables that cannot be measured or controlled when an electrical current passes through tissue.
Accidental contact with exposed parts of electrical appliances or wiring, flashing of electric arcs from high-voltage power lines, lightning, machinery or occupational-related exposures or poking metal objects into an electrical outlet are all possible causes of electrical injury. High-voltage electrical trauma mainly observed in electrical workers produce some of the most devastating of physical injuries. Repeated removal of the damaged tissue and extensive rehabilitation are common while limb amputation rates for victims who experience direct electrical contact can be as high as 75%. In general, most victims who survive high-voltage electrical shock are left permanently disabled.
Away from the workplace, most electrical injuries are due to either indoor household low-voltage (less than 1000 V) electrical contact or outdoor lightning strikes. Domestic household 60-Hz electrical shocks are common and usually result in minor peripheral neurological symptoms or occasionally in skin surface burns. However, more complex injuries may result depending on the current path, particularly following biting or chewing on household appliance cord disclosures or outlets in small children. Compared to a high-voltage shock that usually is mediated by an arc, low-voltage shocks are more likely to produce a prolonged, "no-let-go" contact with the power source. This "no-let-go" phenomenon is caused by an involuntary, current-induced, muscle spasm.
Even without visible burns, electric shock survivors may be faced with long-term muscular pain and discomfort, fatigue, headache, problems with peripheral nerve conduction and sensation, inadequate balance and coordination, and other additional symptoms. Electrical injury, also, often leads to problems with neurocognitive function, affecting speed of mental processing, attention, concentration, and memory. The high frequency of psychological problems is very well established and may be multifactorial in etiology. As with any traumatic and life-threatening experience, electrical injury may result in post traumatic psychiatric disorders which can be as life-changing as a major physical deformity. Involvement of experienced consultants and a supportive environment are required to facilitate rehabilitation, return to gainful employment, and normal family and social functioning.