mechanism in a plausible way Identifying suspicious injuries and consulting with child abuse specialists can prevent subsequent injuries Electrical Burns Burns that result when electrical current passes through the body have unique characteristics Each year, there are more than 4,000 ED visits caused by electrical injuries, mostly in children Electrical burns account for 3% of burn center admissions and are increasing in number Most injuries occur in young children from contact with low-voltage (less than 120 V) alternating household current, often from mouthing plugs or extension cords Severe high-voltage (more than 500 V) injuries are also seen, often in adolescent boys as a consequence of risk-taking behaviors Thermal energy is released in proportion to the amount and duration of electrical current that passes through tissue Current flows preferentially through tissues of low electrical resistance, such as blood vessels, nerves, and muscles Moisture on the skin decreases resistance, accounting for the greater severity of electrical burn injury in the antecubital, axillary, popliteal, and inguinal areas Current arcing through the skin can ignite clothing and cause severe thermal burns in addition to the electrical injury In some direct current electrical burns, a depressed entrance wound and a blown out exit wound can be identified If the current traverses the heart, which occurs more often when the flow is arm to arm, a myocardial injury may occur Current through the heart at certain points of the cardiac cycle can induce ventricular fibrillation or asystole Electrical injury, especially by alternating current, can cause tetany of the musculature that may prolong the contact with the high-voltage source Tetany of the respiratory muscles can lead to suffocation The initial approach to patients of electrical burns is similar to that in other children with severe burns Electrical burns are usually more severe than they appear Significant deep and internal injuries may occur in patients with relatively small external burns Fluid requirements are higher than those predicted by formulas based on percentage of BSA because a larger portion of the injury is internal Destruction of muscle often causes myoglobinuria, so serum creatine kinase and urine for myoglobin should be tested Renal failure can usually be prevented with forced diuresis and alkalinization Electrical injury and edema within fascial compartments can