Case 50 Electrical Injuries

Ean Saberski, David Tsai, and Adnan Prsic

Case 50 Electrical Injuries

Case 50 A 19-year-old man sustained a work-related injury on a high voltage power line. The patient’s right shoulder on arrival to the emergency department is shown.

50.1 Description

  • Evidence of full-thickness burn to the right shoulder, suggesting this as a possible entry site

  • Exit site of electrical current is unclear

50.2 Work-Up

50.2.1 History

  • 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

50.2.2 Physical Examination

  • Advanced Trauma Life Support (ATLS) Protocol: Primary survey

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

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

  • Secondary survey: Complete ATLS secondary survey

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

    • Indications for transfer to a burn center (Table 50.1)

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

    • Vascular examination: Assess perfusion of limbs

    • Otoscopic and ophthalmologic examination assessing extent of injury

    • Orthopedic examination: Assess for any concurrent orthopedic trauma

  • Compartment syndrome assessment

    • High index of suspicion for both upper and lower extremities

    • Disproportionately severe pain to active and passive motion

    • Assess tenderness and firmness of extremity compartments

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

      • Pressure >30 mmHg is an indication for compartment release

    • 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

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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 50 Electrical Injuries
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