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    Electrical Injuries

    Uploaded by

    Ikhwan Salam

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Electrical Injuries

    Uploaded by

    Ikhwan Salam
    34 views1 page

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    Electrical-Injuries

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    34 views1 page

    Electrical Injuries

    Uploaded by

    Ikhwan Salam

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    ELECTRICAL INJURIES

    Copyright © 2019 EM Cases


    Designed by: Sparsh Shah

    Remember that with any burn or electrical injury patient is that they are a trauma patient first.
    Follow your primary and secondary survey and only then attend to the burns and electrical injuries

    RISK STRATIFICATION OF ELECTRICAL INJURIES

    Low Voltage High Voltage


    Additional Factors
    Copyright © 2019 EM Cases
    Designed by: Sparsh Shah

    vs 1. Duration of Contact
    2. Degree of Wetness

    Less than 600V Greater than 600V

    ALETERNATING CURRENT causes prolonged contraction preventing full release from electrical source
    and hence longer duration of contact and more tissue damage compared to DIRECT CURRENT

    LIGHTENING STRIKES

    1. Direct Current High survival rates of 70-90%, but up 80% of survivors


    2. Brief Contact sustain long-term morbidity

    Patients may initially appear deceased with fixed and dilated pupils (autonomic dysfunction)
    and cold mottled extremities from vasospasm

    Asystole occurs from direct depolarization of the myocardium but typically spontaneous
    ROSC is achieved

    Respiratory arrest from medullary paralysis can take longer to resolve and patients may
    develop a secondary hypoxic arrest.

    Emergency Sequelae and Complications of Electrical Injuries

    CARDIAC COMPLICATIONS RHABDOMYOLISIS AND AKI

    Serious cardiac complications from electrical CK elevation correlates to the extent of muscle injury, but
    is not directly related to the probability of developing AKI
    injury relatively uncommon
    Urine myoglobin has poor sensitivity
    Bundle Branch Blocks
    AV Blocks
    QT prolongation Common, Non-Fatal,
    Self Resolving TREATMENT PRINCIPLES
    ST changes
    Atrial Fibrillation

    Correction of volume depletion until the plasma CK


    1
    level is stable
    FATAL ARRYTHMIAS
    Forced alkaline diuresis, using sodium bicarbonate
    2
    to prevent intratubular cast formation
    Ventricular Fibrillation Asystole
    Consider mannitol or furosemide in the
    More common with AC exposures More common with DC exposures 3 presence of obvious myoglobinuria after fluid
    resuscitation to prevent acute tubular necrosis
    Most common fatal arrythmia and renal failure

    ELECTRICAL CORD BITE INJURY COMPARTMENT SYNDROME

    Injury to the corner of the mouth in children is Direct Muscle Injury Indirect Muscle Injury
    not uncommon after chewing on an electrical
    cord
    Burns Bleeding
    Compartment Syndrome

    Regularly assess limbs for:

    Look for any tongue and palate burns. Delayed Significant Pain on Passive Extension
    massive bleeding from the labial artery can
    present 5 – 14 days when the eschar
    Rigid Compartments
    separates

    Signs of Poor Perfusion

    Management Principles of Electrical Injuries

    Fluid Resuscitation Cardiac Monitoring

    Continuous Infusion > Bolus


    1 Minimizes tissue edema that could worsen
    Our experts recommend 6-8 hours of
    tissue damage
    cardiac monitoring for high voltage injuries

    Patient Require More Fluid In patients with a low voltage exposure in


    2 Use the modified Brooke/Parkland Formula
    the absence of chest pain or syncope, the
    literature does not support need for
    Start with RL at 300-500mL/hr cardiac monitoring
    3 Then titrate to a urine output >100cc/hr and
    other signs of adequate organ perfusion

    Disposition

    Asymptomatic low voltage injured patients can be discharged safely after a normal ECG

    For high voltage injuries, the literature suggests observing the patient for 12 hours
    even if they are asymptomatic, with a referral to a burn center

    Finally. discharge instructions are very important as there are delayed complications from
    electrical injuries. Counsel regarding delayed symptoms including psychological,
    neurological, limb ischemia and for kids who bite on an electrical cable, delayed bleeding

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