Electrical Injury Medical Slides

Present the evidence-based approach: Low-voltage (<1000V) with normal ECG, no LOC, no cardiac symptoms → observe 4-6 hours, discharge if asymptomatic with normal repeat ECG. Low-voltage with ANY abnormality (arrhythmia, LOC, abnormal ECG, chest pain) → 24-hour telemetry monitoring. High-voltage (≥1000V) → minimum 24-hour monitoring regardless of initial ECG (delayed arrhythmias reported). Lightning strike → 24-hour monitoring (cardiac arrest at scene is common — VF or asystole). Troponin should be checked in all high-voltage and symptomatic low-voltage injuries. Late arrhythmias after initially normal 24-hour monitoring are exceedingly rare.

Present the "iceberg" concept: external burns dramatically underestimate internal injury in high-voltage cases — current travels along neurovascular bundles, causing deep tissue necrosis not visible on surface. Key assessments: (1) Rhabdomyolysis — CK levels (can exceed 100,000), tea/cola-colored urine, aggressive hydration to maintain UOP >1-2 mL/kg/hr, target CK <5000 before stopping aggressive fluids. (2) Compartment syndrome — high clinical suspicion in any extremity traversed by current, check pressures, early fasciotomy. (3) Vascular injury — arterial thrombosis from intimal damage. (4) Visceral injury — small bowel perforation, solid organ necrosis (rare but described with abdominal current path). Serial exams over 48-72 hours are essential as necrosis evolves.

Present the unique aspects of lightning injury: mechanism differs from industrial electrical injury — massive DC current with extremely brief duration (1-5 ms), flows primarily over the body surface (flashover effect). Reversed triage principle: resuscitate apparently dead victims first (most common cause of death is cardiac arrest — VF or asystole — with good neurological recovery if resuscitated promptly, because lightning often causes transient primary cardiac arrest rather than progressive multiorgan failure). Unique injuries: Lichtenberg figures (fernlike skin markings, pathognomonic, fade in hours), tympanic membrane rupture (50%), fixed dilated pupils (do NOT use as prognostic sign — may be transient from autonomic dysfunction).