0833 Cardiac monitoring in children after household electrical injury

With domestic security a major issue in South African households today, the height of electrified fences and their relative inaccessibility to small children are probably the reasons for few being brought into emergency departments for treatment of electric shock from touching perimeter devices. However such incidents do occur and doctors are faced with the decision of which children need to be admitted for observation. Perhaps a starting point is that security fencing is typically designed to cause pain and to deter; it is not designed to kill. Although voltage is relatively high, current through the fence is low. In general, after electrocution concern is about the effects on cardiac rhythm, and risk factors for morbidity in patients appearing for assessment include exposure to high voltage (>1000 volts), loss of consciousness, tetany, and transthoracic current. In adult studies involving 275 subjects there were cardiac abnormalities in a small number on presentation (ectopics that settled, and atrial fibrillation in 1 that required digitalization), but even with the risk factors, no further cardiac problems developed during observation. In paediatric reviews covering some 400 children in Australia and Canada, concern is expressed because death has occurred even with low voltage, probably as a result of immediate arrhythmia. Risk factors would be the same as for adults, but the list may be extended to also include past cardiac history and an unobserved event. Some would do an ECG in all on presentation, while others require loss of consciousness, tetany, burns or decreased skin resistance as a result of water at the time of the event. As in adults, ECG may be abnormal in a small percentage, and where CPK levels were obtained they may be elevated in a small number, again without subsequent morbidity. Security fence incidents represent a small (if any) component of the above cases, but it seems one can apply the same rules, admitting all with risk factors such as loss of consciousness, history of tetany, transthoracic current, past cardiac history, burns on presentation and wet skin at the time of the event. ECG abnormalities would heighten concern and on their own result in admission, but even if present, no subsequent events appear likely to occur.

Read more:
Ann Emerg Med 1995; 25: 612-7
J Paediatr Child Health 1998; 34: 474-6
Am J Emerg Med 2000; 18: 671-5
Emerg Med J 2007; 24: 348-52