What is the role of ECG and cardiac monitoring in the evaluation of electrical injuries?

Updated: Mar 09, 2020
  • Author: Tracy A Cushing, MD, MPH, FACEP, FAWM; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

All adult patients should have an initial ECG and cardiac monitoring in the ED. The duration of monitoring depends on the circumstances of the exposure; any patients with chest pain, arrhythmia, abnormal initial ECG, cardiac arrest, loss of consciousness, transthoracic conduction, or history of cardiac disease should undergo monitoring. No definitive guideline is available on duration of monitoring for adults, but patients are unlikely to develop significant arrhythmias after 24-48 hours if they have no other significant injuries. Several large reviews have not identified risk of delayed arrhythmia among patients with low-voltage exposure and no arrhythmia upon initial presentation. One such review of 196 exposures concludes that admission for cardiac monitoring is not indicated for such patients. [34]

Several studies have shown that low-voltage (household) exposures in patients with no cardiac complaints and a normal initial ECG can be safely discharged. [35] It is unclear how this applies to patients with preexisting heart disease. In the pediatric population, healthy children with household current exposures (120 to 140V, no water contact) can be safely discharged if they are asymptomatic, without a VF or cardiac arrest in the field, and have no other injuries requiring admission. [26, 36]


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