Electrical injuries - Revision history

Rossdonaldson1: /* Clinical Features */

2024-12-11T18:39:15Z

Clinical Features

← Older revision		Revision as of 18:39, 11 December 2024
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	[[File:PMC4891493 CCR3-4-618-g001.png\|thumb\|Patterned charring along the contact points of a metallic locket due to [[lightning strike]].]]		[[File:PMC4891493 CCR3-4-618-g001.png\|thumb\|Patterned charring along the contact points of a metallic locket due to [[lightning strike]].]]
	[[File:Verbrennung Grad 2b.jpg\|thumb\|Second-degree burn after a high tension line electrical injury.]]		[[File:Verbrennung Grad 2b.jpg\|thumb\|Second-degree burn after a high tension line electrical injury.]]
			[[File:Electrical burn exit wound.jpg\|thumb\|Electrical burn exit wound. Although not easily visable, this patient had serious internal limb tissue injuries that became more evident on day 2 (resulting in amputation).]]
	===Immediate Effects===		===Immediate Effects===
	*[[Cardiac dysrhythmias]]		*[[Cardiac dysrhythmias]]

Rossdonaldson1: /* Evaluation */

2023-11-15T19:20:19Z

Evaluation

← Older revision		Revision as of 19:20, 15 November 2023
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	===Diagnosis===		===Diagnosis===
	*Typically a clinical diagnosis		*Typically a clinical diagnosis

			{{Burn thickness chart}}

	==Management==		==Management==

Rossdonaldson1: /* See Also */

2023-11-15T19:16:11Z

Cmb23: /* Management */

2023-10-28T03:55:34Z

Management

← Older revision		Revision as of 03:55, 28 October 2023
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	*Use [[Parkland formula]] as starting point for [[fluid resuscitation]]		*Use [[Parkland formula]] as starting point for [[fluid resuscitation]]
	**Fluids in first 24 hrs = [[T[[BSA]]]] burned(%) x Wt(kg) x 4ml; Give 1/2 in first 8 hours, then give other 1/2 over next 16 hrs		**Fluids in first 24 hrs = [[T[[BSA]]]] burned(%) x Wt(kg) x 4ml; Give 1/2 in first 8 hours, then give other 1/2 over next 16 hrs
	**Parkland formula frequently underestimates fluid requirements in electrical burns<ref>https://emergencymedicinecases.com/electrical-injuries/</ref>		**Parkland formula frequently underestimates fluid requirements in electrical burns<ref>https://emergencymedicinecases.com/electrical-injuries/</ref> because internal injuries are usually more significant than external burns
	**In healthy individuals start continuous fluids at 300-500 mL/hr and titrate to urine output of 100 mL/hr<ref>https://emergencymedicinecases.com/electrical-injuries/</ref>		**In healthy individuals start continuous fluids at 300-500 mL/hr and titrate to urine output of 100 mL/hr<ref>https://emergencymedicinecases.com/electrical-injuries/</ref>
	*Treat [[rhabdomyolysis]] and [[compartment syndrome]] in usual manner		*Treat [[rhabdomyolysis]] and [[compartment syndrome]] in usual manner
	**If RBCs and/or myoglobin in UA, urine should be alkalinized at minimum of 2 cc/kg/hr until pigments eliminated<ref>Brandt CP, Yowler CJ, Fratianne RB. MetroHealth Medical Center Burn ICU Handbook (Not a policy manual), Cleveland, OH.</ref>		**If RBCs and/or myoglobin in UA, urine should be alkalinized at minimum of 2 cc/kg/hr until pigments eliminated<ref>Brandt CP, Yowler CJ, Fratianne RB. MetroHealth Medical Center Burn ICU Handbook (Not a policy manual), Cleveland, OH.</ref>

Rossdonaldson1: /* Clinical Features */

2020-02-03T19:09:51Z

Clinical Features

← Older revision		Revision as of 19:09, 3 February 2020
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	[[File:PMC4763624 IJD-61-109-g002.png\|thumb\|Lichtenberg figure from [[lightning injury]].]]		[[File:PMC4763624 IJD-61-109-g002.png\|thumb\|Lichtenberg figure from [[lightning injury]].]]
	[[File:PMC4891493 CCR3-4-618-g001.png\|thumb\|Patterned charring along the contact points of a metallic locket due to [[lightning strike]].]]		[[File:PMC4891493 CCR3-4-618-g001.png\|thumb\|Patterned charring along the contact points of a metallic locket due to [[lightning strike]].]]
			[[File:Verbrennung Grad 2b.jpg\|thumb\|Second-degree burn after a high tension line electrical injury.]]
	===Immediate Effects===		===Immediate Effects===
	*[[Cardiac dysrhythmias]]		*[[Cardiac dysrhythmias]]

Rossdonaldson1: /* Clinical Features */

2020-02-03T19:06:39Z

Clinical Features

← Older revision		Revision as of 19:06, 3 February 2020
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	==Clinical Features==		==Clinical Features==
			[[File:PMC5253516 icrp a 1275646 f0001 c.png\|thumb\|Superficial second degree burn from [[lightning injury]].]]
			[[File:PMC4763624 IJD-61-109-g002.png\|thumb\|Lichtenberg figure from [[lightning injury]].]]
			[[File:PMC4891493 CCR3-4-618-g001.png\|thumb\|Patterned charring along the contact points of a metallic locket due to [[lightning strike]].]]
	===Immediate Effects===		===Immediate Effects===
	*[[Cardiac dysrhythmias]]		*[[Cardiac dysrhythmias]]

SuperD: /* Electrical Injury Types */

2020-01-26T20:25:16Z

Electrical Injury Types

← Older revision		Revision as of 20:25, 26 January 2020
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	#'''Electric Arc'''		#'''Electric Arc'''
	#*Associated with high voltage sources		#*Associated with high voltage sources
	#*Ionized particles with temperature 3000 °C–20,000 C<ref name="Epidemiology">Kym D, Seo DK, Hur GY, Lee JW. Epidemiology of electrical injury: Differences between low- and high-voltage electrical injuries during a 7-year study period in South Korea. Scand J Surg. 2015 Jun;104(2):108-14.</ref>		#*Ionized particles with temperature 3000 °C–20,000 °C<ref name="Epidemiology">Kym D, Seo DK, Hur GY, Lee JW. Epidemiology of electrical injury: Differences between low- and high-voltage electrical injuries during a 7-year study period in South Korea. Scand J Surg. 2015 Jun;104(2):108-14.</ref>
	#*Can jump 2-3cm per 1000V<ref name="Epidemiology" />		#*Can jump 2-3cm per 1000V<ref name="Epidemiology" />
	#*May radiate enough heat to burn persons 10ft or more away from the arc		#*May radiate enough heat to burn persons 10ft or more away from the arc

SuperD: /* DC */

2020-01-26T20:23:01Z

← Older revision		Revision as of 20:23, 26 January 2020
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	====DC====		====DC====
	*Direct current most often demonstrates flow-over phenomenon		*Direct current most often demonstrates flow-over phenomenon
	*~~Lightening~~ can reach 1-5 million volts, but current flows over the body and exits to the ground		*Lightning can reach 1-5 million volts, but current flows over the body and exits to the ground
	*May result in little tissue damage but [[cardiac dysrrhythmias]] are still of great concern		*May result in little tissue damage but [[cardiac dysrrhythmias]] are still of great concern

Hoxbox: /* Cardiac Dysrhythmias */

2019-12-19T12:25:35Z

Cardiac Dysrhythmias

← Older revision		Revision as of 12:25, 19 December 2019
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	**Most common [[dysrhythmia]] at presentation is [[A-fib]] ([[V-fi]]b is more common, but patients are dead PTA)		**Most common [[dysrhythmia]] at presentation is [[A-fib]] ([[V-fi]]b is more common, but patients are dead PTA)
	**Asymptomatic patients with normal [[ECGs]] do not develop later dysrhythmias after <1000V injuries		**Asymptomatic patients with normal [[ECGs]] do not develop later dysrhythmias after <1000V injuries
			***For uncomplicated electrical injuries if normal EKG then routine ECG monitoring and cardiac biomarkers unnecessary<ref>Pilecky D, Vamos M, Bogyi P, et al. Risk of cardiac arrhythmias after electrical accident: a single-center study of 480 patients. Clin Res Cardiol. 2019;108(8):901–908. doi:10.1007/s00392-019-01420-2 Abstract at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6652167/</ref>.

	===Cardiovascular Injury===		===Cardiovascular Injury===

ClaireLewis at 18:56, 28 September 2019

2019-09-28T18:56:29Z

← Older revision		Revision as of 18:56, 28 September 2019
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	===[[Cardiac Dysrhythmias]]===		===[[Cardiac Dysrhythmias]]===
	*Fatalities due to [[asystole]] or [[V-fib]] usually occur prior to arrival		*Fatalities due to [[asystole]] or [[V-fib]] usually occur prior to arrival
	**Most common [[~~dysrrhythmia~~]] at presentation is [[A-fib]] ([[V-fi]]b is more common, but patients are dead PTA)		**Most common [[dysrhythmia]] at presentation is [[A-fib]] ([[V-fi]]b is more common, but patients are dead PTA)
	**Asymptomatic patients with normal [[ECGs]] do not develop later dysrhythmias after <1000V injuries		**Asymptomatic patients with normal [[ECGs]] do not develop later dysrhythmias after <1000V injuries

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	*Contraction band necrosis<ref>Koumbourlis AC. Electrical injuries. Crit Care Med. 2002 Nov;30(11 Suppl):S424-30.</ref>		*Contraction band necrosis<ref>Koumbourlis AC. Electrical injuries. Crit Care Med. 2002 Nov;30(11 Suppl):S424-30.</ref>
	*Medial necrosis of large vessels		*Medial necrosis of large vessels
	**Aneurysm formation		**[[LV aneurysm\|Aneurysm]] formation
	*Coagulation necrosis of small vessels		*Coagulation necrosis of small vessels
	**Can lead to [[compartment syndrome]]		**Can lead to [[compartment syndrome]]
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	===CNS Injury===		===CNS Injury===
	*Occurs in 50% of patients with high-voltage injuries		*Occurs in 50% of patients with high-voltage injuries
	*Brain injury ranges from transient LOC to [[CVA]] to [[respiratory arrest]]		*Brain injury ranges from transient [[syncope\|LOC]] to [[CVA]] to [[respiratory arrest]]
	*High voltage injuries involving head are frequently associated with coma and persistent vegetative state		*High voltage injuries involving head are frequently associated with [[coma]] and [[Persistent Vegetative State\|persistent vegetative state]]

	===Orthopedic Injury===		===Orthopedic Injury===
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	**Document presence or absence of cataracts following all electrical injuries		**Document presence or absence of cataracts following all electrical injuries

	===Auditory Injury===		===[[hearing loss\|Auditory Injury]]===
	*May be damaged by current or hemorrhage		*May be damaged by current or hemorrhage
	*Check hearing in all patients		*Check hearing in all patients
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	===Pediatric Considerations===		===Pediatric Considerations===
	*In general, evaluate as for the adult, looking for multi-system involvement		*In general, evaluate as for the adult, looking for multi-system involvement
	*Perform an ECG in all patients, regardless of voltage		*Perform an [[ECG]] in all patients, regardless of voltage
	*An oral commissure burn (from chewing on power cord) will create significant edema and necrosis		*An oral commissure burn (from chewing on power cord) will create significant edema and necrosis
	**The child may need Plastic Surgery or Head and Neck Surgery consultation to avoid microstomia		**The child may need Plastic Surgery or Head and Neck Surgery consultation to avoid microstomia
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	==Evaluation==		==Evaluation==
	===Workup===		===Workup===
	*12-lead ECG		*12-lead [[ECG]]
	*CBC		*CBC
	*CMP		*CMP
	*Lactate		*[[Lactate]]
	*[[Troponin]]		*[[Troponin]]
	*CK		*CK
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	*Abnormal [[ECG]] or observed dysrhythmia		*Abnormal [[ECG]] or observed dysrhythmia
	*Cardiac biomarkers positive		*Cardiac biomarkers positive
	*Persistent [[chest pain]], paresthesias, or [[hypoxia]]		*Persistent [[chest pain]], [[paresthesias]], or [[hypoxia]]
	*[[Cardiac arrest]]		*[[Cardiac arrest]]
	*History of significant cardiac disease or CAD risk factors		*History of significant cardiac disease or CAD risk factors

← Older revision		Revision as of 19:16, 15 November 2023
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	==See Also==		==See Also==
	*[[Lightning Injuries]]		*[[Lightning Injuries]]
			*[[Burns]]

	==External Links==		==External Links==