General

Question 1

What is considered high voltage and which is worse, AC or DC current

Answer 1

> 1000 volts, AC worse than DC

Question 2

Symptoms of electric shock

Answer 2

Immediate arrest (v fib or asystole)
Seizure, confusion, altered mental status
Visual changes (corneal burns, RD, uveitis), ruptured TM, tinnitus
Thermal burns (usually dorsum of hand, size of burn does not correlate with degree of underlying injury)
Arc burns (over areas of different resistance– usually extensive tissue injury)
Paresthesias
Injuries associated with trauma (eg post shoulder dislocation)

Question 3

Management of electrical burns

Answer 3

ABCs
Cardiac monitor: can have dysrhythmias, QT prolongation
Labs including ck, UA, CBC and lytes
Ivf for rhabdo, aim for urine output 1-2 ml/kg/hr
Local wound care, tetanus prophylaxis
Trauma work up as indicated

Question 4

Complications of electrical burns

Answer 4

Delayed bleeding (esp labial artery in pediatrics)
Renal failure, rhabdo, DIC
arterial and venous thrombosis

Question 5

Compare and contrast lightening to high voltage electrical injuries

Answer 5

Lighting short duration, very high voltage, usually asystole if cardiac arrest, extensive external injuries with minimal internal, rarely rhabdo, rarely needs fasciotomy

Question 6

Clinical presentation and findings in lightning injury

Answer 6

Cardiac arrest (reverse triage if on scene– these first)
Reps arrest
Injuries associated w trauma
Keranoparalysis: usually transient paralysis and extreme vasoconstriction of extremities due to sympathetic activation– blue pulseless mottled extremities
Skin: licthenberg (Ferning), linear burns, punctuate, thermal
Seizure, altered mental status
TM rupture, tinnitus
Anisocoria, dilated pupils

Question 7

Who to admit after lightning injury

Answer 7

Any evidence cardiac injury (on ecg or exam)
Neurologic abnormalities
Extensive burns or trauma