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hypotensive from resultant diuresis and hypovolemia - adjust IV fluids accordingly. Monitor blood pressure,
urinary output.
Primitive: If sterile IV solutions are not available or are in limited supply, and the patient has bowel sounds
present and is not vomiting, consider substituting an oral rehydration solution (ORS). You may use any of
the commercially available solutions (e.g., Ricelyte, Cera-Lyte) or make your own ORS**, which can be taken
orally given through a nasogastric tube “drip” or “infusion”. If the patient develops myoglobinuria, attempt to
alkalinize the urine by increasing the amount of baking soda (bicarbonate) to 1-3 tbsp/L and adjusting the drip
rate to achieve urine output of 1-2 ml/kg/hour. Adjust the amount of baking soda added to the ORS based on a
target urine pH of 6.5 or greater. The solution can be placed into a clean, used IV fluid bag that has been
cut open just enough at the top to add the ORS. Then hang the bag with IV tubing attached and the other
end of the IV tubing attached to the NG tube. Adjust the flow rate in the same manner as any other IV
fluid infusion. Adjust the continuous NG “drip” to maintain adequate urine output. The bag and tubing may
be used repeatedly in the same patient. Add more ORS solution to the bag as needed. NOTE: If patient
will be going to surgery within 4-6 hours, discontinue oral/NG tube intake unless told otherwise by
the surgical team.
** ORS Recipe: 1 tsp of salt, 1 tsp of salt substitute (potassium chloride), 1 tsp baking soda (bicarbonate), 2-3
tbsp of table sugar or 2 tbsp of honey or Karo syrup, all mixed in 1L of clean or disinfected water.
Patient Education
Medications: Furosemide and mannitol are potent diuretic agents.
Prevention and Hygiene: Remember scene safety. Turn off the electrical source before making physical
contact with the victim. Do not become a victim yourself. Remember that lightning does strike twice in the
same area. Avoid being the tallest object in an open area, and being near one. Shelter in a grove of trees if
possible. If caught in the open, crouch low and/or seek low ground.
Follow-up Actions
Return Evaluation: If myoglobinuria does not clear within 24-36 hours of adequate urine diuresis and
alkalinization, then a source of undetected myonecrosis or muscle ischemia should be sought. Look for areas
of swelling and tenderness
Consultation Criteria: Except for the most trivial of electric shocks, all victims of electrical injury should
be evaluated by a physician as soon as tactically &/or operationally feasible. Patients with suspected
compartment syndrome might require “limb-saving” fasciotomy (see Procedure: Compartment Syndrome
Management). NOTE: Fasciotomy is not the same procedure as escharotomy, which is done on 3rd degree
burn victims to relieve constricting overlying burn eschar.
Chapter 32: Non-Lethal Weapon Injuries
Non-Lethal Weapon Injuries: Laser Eye Injuries
Lt Col John McAtee, USAF, BSCIntroduction: Even low levels of laser energy can burn the cornea or retina of the eye. The retina is
particularly vulnerable because the optics of the eye focus the damaging energy of laser light on the retina.
The severity of injury depends on duration of exposure, laser wavelength, area of retina damaged and type
of lenses or personal protection used. Due to the importance of vision for mission execution and success,
as well as the need to protect others from similar burns, laser injuries must be promptly identified, personnel
must be quickly moved from the threat environment and the command (and intelligence personnel) must be
immediately notified.
Subjective: Symptoms
Range from mild eye irritation to extreme pain and photophobia, immediate partial or complete loss of vision
(may be temporary), or loss of peripheral vision