Children who have sustained minor household electrical injuries and are asymptomatic usually not require laboratory evaluation, cardiac evaluation, or hospitalization In more severe injuries, entry and exit wounds and arc burns are poor predictors of internal damage Tissue that appears viable initially may become ischemic over several days Current Evidence An electrical injury occurs when a person comes into contact with the current produced by a human-made or natural source The spectrum of electrical injury is enormous, ranging from low-voltage household accidents to million-volt lightning strikes ( Table 90.8 ) Appropriate management requires an understanding of the basic physical aspects of electricity, the physiologic responses to injury, and the potential for immediate and delayed damage Lightning that strikes individuals carries a 30% risk of mortality and claims approximately 100 lives annually in the United States The death rate is highest among children ranging from 15 to 19 years of age The majority of struck-bylightning injuries in the United States originate in the South and the Midwest Harnessed electrical power is responsible for approximately 700 deaths/year, of which 10% are children Household electrical cords are the major cause of electrocution in children 12 years of age and younger, with an estimated 1,000 ED visits for oral electrical burns from 1997 to 2012 High-tension electrical injuries dominate in older children who climb on trees, buildings, or utility structures Tasers and stun guns, which are high-voltage, low-current stimulators, cause pain due to involuntary muscle contractions The severity of electrical injury depends on six factors: (i) The resistance of skin, mucosa, and internal structures; (ii) the type of current (alternating or direct); (iii) the frequency of the current; (iv) the intensity; (v) the duration of contact; and (vi) the pathway taken by the current Precise separation of the effect of these factors, which are interrelated, is impossible Together, they produce either heat or current, and a variety of injuries result