Background
• Current: Measure of amount of energy flowing through an object; in amperes (A)
Approach
• Early & continuous cardiac monitoring for dysrhythmias
• Evaluate for concomitant trauma (fall, injury); maintain c-spine precautions
• Divided in low voltage <500 & high voltage
History
• Usually obvious & reported (eg, occupational injury of electrician, home handyman); pt reports minor shock (tingling) related to home appliance use
• “3rd rail” contact from light-rail mass transportation system
• Toddler w/ burns to corners of mouth (chewing) or hands (playing w/ socket)
• Bimodal distribution w/ most pts <6 or adult workers
Findings
• VF more common w/ low voltage AC, asystole w/ high voltage AC or DC
• Respiratory arrest via chest wall paralysis or respiratory center of brain possible
• Skin wounds may appear minor & entry/exit wounds may be present (examine bottoms of feet for exit); may be more severe than they appear due to deep-tissue injury
• Long-bone fx, scapular fx, shoulder dislocation, spinal fx from mechanical trauma caused by whole body tetanic contractions or trauma of being blown back
• Perforated TMs, delayed cataracts in 6% of pts
Evaluation
• ECG, CBC, Chem 7, cardiac enzymes (rhabdomyolysis), UA (myoglobin)
Treatment
• Resuscitate, eval for trauma, immobilize c-spine, continuous cardiac monitoring
• High-volume IV crystalloid (NS)
• Urinary catheter placement: Target urine output: 0.5–1 mL/kg/h
• If rhabdomyolysis (↑ CK, +UA dip), maintain high UOP until urine dip negative
• Goal serum pH 7.45–7.55
• Alkaline urine (pH > 6.5) to ↑ excretion of acidic myoglobin by ↑ solubility; D5W + 150 mEq NaHCO3 OR D5 ¼ NS or D5 ½ NS + 100 mEq NaHCO3
• Diuresis w/ Lasix 20–40 mg IV or mannitol 25 g IV (then 12.5 g/kg/h) prn
• Treat wounds the same as thermal burns (10 d)
• Compartment pressures ± fasciotomy if sx of compartment syndrome
• Splint injured extremities in best “position of fxn” to minimize contractures
Disposition
• If asx & nl exam, can be discharged
• If mild cutaneous burns & nl ECG, nl urine dip, observe for 2 h, then d/c
• ECG Δ, myoglobinuria, entry/exit burns, partial/full thickness burns: Admit burn center
Pearls
• Electrical injuries are often minor, but may be more serious than they 1st appear. If any concern, observe for 6–12 h.
• Pediatric oral “bite” burns may develop delayed labial artery bleed at 2–3 wk
