LIGHTNING & ELECTRICAL INJURIES

Question 1

KEY CONCEPTS

Answer 1

TYPE OF EXPOSURE
High voltage (>600 V)
Low voltage (<600 V)
Electrical Arc
Lightning

A complete circuit:
One terminal of a voltage source -> contact with persion -> other contact with person -> terminal of the voltage source (ground)

TYPE OF CURRENT
AC (alternating current)
DC (direct current)

OHM’s LAW
Voltage = Resistance (Ohm’s) x Current (Amps)

STANDARD HOUSEHOLD ELECTRICITY
AC

INJURIES
AC: defibrillarion
DC, high voltage > 600: asystole
Sinus tachycardia and PVCs MC arrythmias
Keraunoparalysis: neurologic and muscular stunning, LE > UE
Electroporation: cell membrane damage
Stimulation of nerves and muscles
Temporary Autonomic Dysfunction: transient pupillary dysfunction (dilated pupils)
Thermal Injury
Renal Failure (rhabdomyolysis)
Trauma from tertiary blast / tetanic contraction
Flash cutaneous burns from electrical arc

LONG TERM SEQUELAE
neuropathies, concussion, and chronic pain syndromes

Question 2

MANAGEMENT

Answer 2

High voltage (>600 V)
Low voltage (<600 V)
Electrical Arc

FLUID
1 L bolus fluid, target U/O 1.5 mL / kg / hr

INVESTIGATIONS
ECG: everyone
CBC, lytes, BUN, Creatinine, CK, UA (severe injury)

PREGNANT > 20 weeks GA
U/S
Fetal monitor for min 4 hours
Monitor for 24 hrs if LOC, ECG changes, maternal CV disorger

MONITORING
24 Cardiac Monitor: direct strike, LOC symptomatic, arrythmia, ECG changes, high voltage (>600 V)

DISPOSITION: HIGH VOLTAGE
All patients having had a >600 V AC should be admitted for observation

DISPOSITION: LOW VOLTAGE INJURY
Asymptomatic patients who sustain and eletrical shock < 240 V AC with normal ECG and a normal examination can be discharged home

Question 3

DOCUMENTATION

Answer 3

HPI
Ask about:
High voltage (>600 V)
Low voltage (<600V)
Electrical Arc
AC
DC
Contact Time
Points of contact

Burns
Trauma

LOC

PHYSICAL EXAM
Check for:

CNS
Temporary Autonomic Dysfunction: transient pupillary dysfunction (dilated pupils)
Keraunoparalysis: neurologic and muscular stunning, LE > UE
Temporary Autonomic Dysfunction: transient pupillary dysfunction (dilated pupil

TRAUMA SURVEY
Entry / Exit Burns
Labial artery injuries
Spinal Trauma
Posterior Dislocation