emDocs - July 24th, 2020 - By Helman A. Originally published at EM Cases
"Key Take Home Points for Electrical Injuries
- Think trauma and tox first. Don’t get distracted by the burns
- Perform serial examinations of limbs to assess for compartment syndrome and assume rhabdomyolysis if tea colored urine
- Cardiac complications of electrical injuries are rare with VF occurring immediately after high voltage AC exposure; while ECG is recommended for all patients, only patients with risk factors and/or clinical presentation consistent with cardiac ischemia require troponins
- Cardiac monitoring is only required for low voltage injured patients with chest pain or syncope and all high voltage injured patients
- Electrical injured patients generally require more fluid than suggested by The Modified Brooke/Parkland Formula
- Fluid formulas are starting points only, titrate carefully, assessing urine output and signs of end organ perfusion to avoid over and under resuscitation
- Consider alkalinizing the urine and forced diuresis after adequate fluid resuscitation for patients with tea colored urine and/or a CK in the thousands
- Asymptomatic low voltage (<600V) injured patients only require an ECG with no further workup or observation if the ECG is normal
- Refer all high voltage (>600V) injured patients to a burn center
- For patients going home with electrical injuries, counsel regarding delayed symptoms including psychological, neurological, limb ischemia and for kids who bite on an electrical cable, delayed bleeding"