Emergency Medicine

214 Environmental Emergencies

ELECTRICAL BURNS, ELECTROCUTION AND LIGHTNING STRIKE

2 Injuries are associated with:

(i) Electrical flash burns with full-thickness injury at points of

electricity entry and exit, or flame burns secondary to clothing

ignition.

(ii) Extensive tissue damage, deep muscle necrosis, and compartment

syndrome requiring fasciotomy and potentially limb amputation.

(iii) Tetanic muscle spasm causing long-bone fracture, vertebral crush

fracture, muscle tears and joint dislocations.

(iv) Indirect injury from a resultant fall.

3 According to the pathway the charge follows, other effects include:

(i) Lungs: asphyxia from respiratory paralysis and lung parenchyma

burns.

(ii) Heart: cardiac arrest or arrhythmia. The most common cardiac

arrest rhythm is VF.

(iii) Brain and CNS: confusion, coma, cerebral haemorrhage, spinal

cord damage and peripheral nerve damage.

(iv) Gastrointestinal tract: bowel perforation and intestinal ileus.

(v) Kidneys: acute kidney injury secondary to tubular deposition of

myoglobin and haemoglobin.

(vi) Visceral and connective tissue: immediate damage to nerves,

muscle and bone from heat, vascular thrombosis or delayed

secondary haemorrhage.

(vii) Eyes and ears: dilated pupils, uveitis, vitreous haemorrhage,

ruptured eardrum, deafness and the late development of cataracts.

4 Gain i.v. access and send blood for FBC, U&Es, blood sugar, CK, group and

save (G&S) and ABGs. Attach a cardiac monitor and pulse oximeter to the

patient.

5 Perform an ECG.

6 Request a CXR, pelvic or limb X-rays, and or a CT head and neck scan

according to the suspected additional injuries.

MANAGEMENT

1 Assess the airway, give oxygen and commence an i.v. infusion ensuring

adequate volume replacement guided by the blood pressure and urine

output.

(i) Fluid requirements are higher than they appear from assessment

of the burnt areas alone. Aim for a urine output of 100 mL/h if

there is myoglobinuria.

2 Examine for major injuries secondary to falls and treat accordingly.

3 Refer patients to the specialist burns unit or surgical team for admission.

Escharotomy, fasciotomy, surgical debridement and limb amputation may

all become necessary.