Although internal organ damage by current is rare, there are reports of paralytic ileus and necrosis of the gallbladder, colon, pancreas, and liver. These visceral injuries are often associated with burns of the abdominal wall. Cardiac injury
The main cause of death following electric shock is cardiac arrest, usually as a result of ventricular fibrillation ( Fontanaro.s.a.,1993). Both low and high voltages can produce life-threatening arrhythmias, with some developing several hours after the accident. High current flows (> 10 A) tend to cause asystole. Although myocardial infarction is rare, areas of necrosis in heart muscle and conducting tissue have been reported after electrocution. Diagnosis of cardiac injuries after high-voltage contact is difficult. ECG abnormalities (usually non-specific ST-T changes) may be transient or even absent, presumably due to the diffuse nature of the myocardial damage. Elevation of creatine kinase MB isoenzyme suggests cardiac injury, although under conditions of electrical stimulus it can be released from skeletal muscle. Patients at high risk of myocardial injury can be identified by extensive body surface burns and the presence of upper and lower body exit and entrance wounds. Clearly, if cardiac malfunction is suspected, echocardiographic and cardiac output studies are indicated. Myocardial injury can also result from low-voltage shocks. However, Australian experience suggests that after domestic 240-V shocks, asymptomatic patients with normal ECGs can be safely discharged home (Cunningham 1991).
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