Age, gender, handedness, and occupation

Past medical, surgical, and social history

Source of electricity: Power line, power outlet, lightning, electrical arc, etc.

Intensity of electricity: High voltage (≥1,000 V) or low voltage (<1,000 V)

Points of contact with electricity: Grasp of power source, fall onto power source, or nearby flash from power source

Context of injury: Concurrent with fall or other trauma

Type of electrical current: Alternating current (AC) or direct current (DC)

Duration of contact with power source

Advanced Trauma Life Support (ATLS) Protocol: Primary survey

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  ABCs: Assess if airway is maintained and assess for inhalation injury

  
  
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  Expose patient for evaluation; remove all potentially constricting clothing and jewelry

Secondary survey: Complete ATLS secondary survey

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  % Total Body Surface Area burn: Rule of Nines (see Fig. 49.1)

  
  
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  Indications for transfer to a burn center (Table 50.1)

  
  
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  Neurological examination: Establish baseline neurological examination, assess sensation in all limbs, assess mental status, and evaluate cranial nerves

  
  
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  Vascular examination: Assess perfusion of limbs

  
  
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  Otoscopic and ophthalmologic examination assessing extent of injury

  
  
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  Orthopedic examination: Assess for any concurrent orthopedic trauma

Compartment syndrome assessment

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  High index of suspicion for both upper and lower extremities

  
  
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  Disproportionately severe pain to active and passive motion

  
  
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  Assess tenderness and firmness of extremity compartments

  
  
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  Measure compartment pressures: Can use needle pressure gauge (STIC pressure monitor; Stryker, Kalamazoo, MI)

  
  
  
  
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    Pressure >30 mmHg is an indication for compartment release

  
  
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  Pain, pallor, paresthesias, paralysis, and pulselessness are all indications for release and are late findings

  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  

  Table 50.1 Indications for referral to a burn center

  Partial-thickness burns greater than 10% total body surface area (TBSA)	Burns that involve the face, hands, feet, genitalia, perineum, or major joints
  Third degree burns in any age group	Electrical burns, including lightning injury
  Chemical burns	Inhalation injury
  Burn injury in patients with pre-existing medical disorders that could complicate management, prolong recovery, or affect mortality	Any patient with burns and concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality
  Burned children in hospitals without qualified personnel or equipment for the care of children	Burn injury in patients who will require special social, emotional, or rehabilitative intervention