Electrical Burns: Early Management

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The following considerations apply in the early management of a patient with an electrical injury:

KEY STEPS:

  1. Cardiac Monitoring
  2. Aggressive Management of Myoglobinuria
  3. Additional Fluid Resuscitation
  4. Management of Compartment Syndrome




Cardiac Monitoring

Electrical injuries may result in a variety of cardiac arrhythmias, including asystole and ventricular fibrillation which manifest very soon after injury.

CPR should be initiated for those in cardiac arrest

 Aggressive Management of Myoglobinuria

Myoglobinuria in Electrical Burn Injury

Myoglobinuria in Electrical Burn Injury
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Muscle damage can result in myoglobinuria and haemoglobinuria. These pigments can exacerbate acute renal failure. Prompt diuresis will help to protect against pigment deposition in the renal tubules and kidney damage.

If pigment is evident in the urine, intravenous fluids should be increased to create a urine output of 75 – 100 mls/hr to ‘flush’ the kidneys. Diuretics may be required as an adjunct.

Additional Fluid Resuscitation

Fluid resuscitation requirements in an electrical burn are usually more than that indicated by the extent of the cutaneous burn. Muscle damage that is not immediately evident can cause fluid loss which is not accounted for by the standard Parkland formula. It is important to always titrate fluid resuscitation according to urine output goals.

Compartment Syndrome

Patients with high voltage electrical injuries are at risk of developing compartment syndrome. Damaged muscle swells and the high pressure within the investing fascia can obliterate blood flow and result in further muscle necrosis.

  • Elevate affected areas to help to minimise swelling

Signs of compartment syndrome:

  • ‘tight’ muscle compartments in limbs
  • pain at rest
  • increased pain on passive extension of digits
  • decreased distal sensation
  • decreased distal perfusion

If multi-compartment fasciotomy is required, consult with Adult Retrieval Victoria and the appropriate Burn Service before proceeding

The Alfred Hospital gratefully acknowledges the ongoing support and contribution of Skilled Medical in funding this project.  For more information on Skilled Medical, please visit www.skilledmedical.com
Supported by:

Ambulance Victoria The Alfred Victorian Adult Burn Services at The Alfred The Royal Children's Hospital Melbourne