ENVIRONMENTAL EMERGENCIES■ Paresthesias
■ Seizure
■ Thermal source contact burns
■ Size does not correlate with underlying tissue injury.
■ Most commonly on hand
■ Arc burns(kissing burns) = arc of extremely high voltage current across
flexor creases →extensive damage.
■ Visual changes from corneal burns, retinal detachment, uveitis
■ Tinnitus, hearing loss, ruptured tympanic membranes
■ Muscular pain
■ Traumatic injuries (blunt or blast)
■ Posterior shoulder dislocationsfrom being “thrown from source”
DIAGNOSIS
■ Diagnosis of electrical injury is typically obvious on presentation.
■ Virtually any organ can be injured, therefore detailed evaluation is
warranted.
■ ECG and monitoring:
■ Dysrhythmias, heart block, QT prolongation, nonspecific ST-T changes
are all possible.
■ Labs include: CBC, electrolytes, UA, CK.
■ Standard trauma evaluation, as necessary
TREATMENT
■ ABCs
■ Intravenous fluids
■ Monitor urine output (goal 1–2 mL/kg/hour).
■ Treat rhabdomyolysis, if present.
■ IV fluids
■ Alkalinization of urine (three ampoules of NaHCO 3 in 1 L D 5 W)
■ Trauma management, as necessary
■ Wound (burn) care and tetanus prophylaxis
■ Low voltage injuries can be safely sent home.
COMPLICATIONS
■ Renal failure from rhabdomyolysis
■ DIC (uncommon)
■ Arterial and venous thrombosis
■ Labial artery burns can present with delayed severe bleeding.
■ Cataracts
A 32-year-old male is brought to the ED for evaluation after being found
down in a field after a thunderstorm. He has no recollection of events. He
is complaining of ringing in his ears and states that he is unable to move
his extremities. What physical exam findings would help you determine if he was
struck by lightning?
Fernlike markings (also known as Lichtenberg figures) are pathognomonic
for lightning injuries and usually fade in a few hours. Other findings consistent
with lightning injury include tympanic membranes rupture (seen in 50%), tinnitus,
hearing loss, and paralyzed, cold, and pulseless extremities (keraunoparalysis, a
temporary condition due to sympathetic nervous system activation).Primary cardiac arrest in
electrical injuries = asystole or
ventricular fibrillation.