Electrical Injuries
Starting off, an electrical injury patient is a trauma patient first, make sure to follow primary and secondary survey, EFAST, etc.
May require intubation if obtunded
r/o TBI, spinal cord, blunt thoracic, etc.
Risk Stratification
Low voltage (<600V) – household or office exposures lower risk injuries
High voltage (>600V) – industrial settings, subway rails, power lines are high risk injuries
Alternating Current (AC) – causes prolonged contraction and release of muscle which prevents full release from electrical source which will cause longer contact duration and more tissue damage compared to Direct Current (DC)
Lightning strikes (up to 1 billion V) are DC with brief contact
80% have long term morbidity, 10-30% mortality
Asystole from depolarization of myocardium but sponteous ROSC often achieved
Respiratory arrest from medullary paralysis
For lightning strike mass casualty incident, resuscitate those who appear dead first
Wound Care – saline moistened gauze (ideally sterile) and antibiotic ointment (silver sulfadiazine cream, bacitracin, mupirocin) unless transferring to burn center which mostly prefer just sterile moistened gauze
Cardiac Complications
Bundle branch blocks, AV blocks, QT prolongation, ST changes, Afib – most resolve spontaneously, Vfib (more with AC, asystole more with DC)
STEMI can arise rarely from electrical shocks, can consider trop
Compartment Syndrome – need to monitor, especially burn sites
Rhabdomyolysis/AKI
CK correlates to extent of muscle injury
Can have tea colored urine
Can have hyperK from AKI/Rhabdo but usually resolves with fluids
Treat as normal rhabdo with IVF and consider urine alkalinization with bicarb gtt
Electrical cord bite injury
Children can bite on electrical cords causing damage to oral pharynx, delayed massive bleeding from labial artery can arise – can grip lips with fingers/gauze to decrease bleeding
Cardiac Monitoring
Low voltage exposure w/o chest pain/syncope, no need for ECG monitoring
High voltage exposure – cardiac monitor 6-8hr
Delayed complications – altered mental status, memory loss, limb ischemia from vasospasm, parasthesias, cataract formation, delayed anerusym formation, delayed thrombosis
Disposition
Asymptomatic low voltage can be discharged
High voltage obs for 12 hrs with 6 hrs cardiac monitoring
Admit for dysrhythmia, AMS
Refer to burn center if significant burn injuries