Friday, July 24, 2020

Electrical Injuries

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"