So a kid gets bounced around hospitals before being sent to our ED for admission. Shortly after, we send the kiddo home with some local wound care to a blister.
Low voltage electrocution (<1000 volts) is a common household injury that is usually a result of contact with electric cords and wall outlets. One of the main concerns with electrocution is related to cardiac consequences, specifically ventricular fibrillation and direct myocardial injury.
Chen et al reviewed the literature pertaining to the management and outcome of children exposed to a low voltage current (usually household appliances with a maximal voltage of 240V). They summarized the results of 7 retrospective studies that evaluated the relationship between the type of voltage, patients symptomatology at the scene (cardiac arrest, ventricular fibrillation), EKG findings (when an EKG was performed), and patient outcome.
The upshot of the review article was that healthy children who are exposed to household currents, when asymptomatic at the field and in the ED, had a very low risk of developing cardiac arrhythmias. When the children did have 'benign' arrhythmias (mainly sinus tacchycardia, vernticular premature complexes, and premature junctional complexes), those resolved spontaneously. Children who did not have abnormal EKG findings never developed any late arrhythmias.
The authors concluded that it is safe to discharge asymptomatic children exposed to household currents without and EKG or telemetry.
Reference:
Chen EH, Amit S. Do children require ECG evaluation and inpatient telemetry after household electrical exposure. Annals of Emergency Medicine 2007;49:64-67
I remember last time I lived this situation with a normal EKG but clear entrance and exit marks on right hand and left foot. We kept the boy with EKG monitoring all night long. I cannot remember the details. This was a 7 or 8-year-old boy that touched the bulb of a lamp at the bathroom and was wearing a plastic sandal only on one foot. As far as I remember, at arrival he had a round dark little spot on the plantar side of 4th-5th metatarsians, say about 1 cm in diameter. We had no beds in the PICU so he occupied one bed in a common room in the surgery unit. The anesthesist on ward insisted on keeping the EKG monitorization and taking a vein access AND she made 3-4 checks during that night. I just followed the entrance as a common burn but don´t know if the anesthesist did some extra follow-up. The plantar spot merged in colour with the surrounding skin while he had an ugly blister at the finger tip that "reepithelized" without problems in 3 weeks.
ReplyDeleteMuch ado about nothing? I think the official PALS text advocates this monitoring.