Electric Injury

1. First responders should remove the patient from the electricity source while avoiding injury themselves.
2. In cases of cardiac arrest due to arrhythmia after electrical injury, follow advanced cardiac life support (ACLS) protocol and provide hemodynamic monitoring if spontaneous circulation returns.

Special considerations for electrical injury:

- Extremity compartment syndrome: Particularly with high-voltage electric injury (> 1000 V), skin contact points (cutaneous burns) of limited extent can hide extensive soft-tissue damage. Observe the patient closely for clinical signs of compartment syndrome (refer to the Circumferential Burns section above), and the Extremity Compartment Syndrome or Appendix E).
- Fasciotomy vs escharotomy: Fasciotomy is typically required for extremity compartment syndrome caused by electrical injury. Note that escharotomy, which relieves the tourniquet effect of circumferential burns, will not relieve elevated muscle compartment pressure due to myonecrosis associated with high-voltage electric injury.
- Rhabdomyolysis: Compartment syndrome and muscle injury may cause rhabdomyolysis, causing pigmenturia and acute kidney injury. Patients with clinically significant pigmenturia will have visibly red or brown urine. If available, monitor CK levels every 6 hours. Balancing crystalloid resuscitation to avoid renal failure without over resuscitation is a challenge in these patients.
- Increased fluid goals: Fluid resuscitation requirements are higher than those predicted for a similarly sized thermal burn. Isotonic fluid infusion should be adjusted to maintain UOP 75-100 mL/hr in adult patients with pigmenturia until it resolves (urine returns to clear or light yellow). Urinalysis-based heme pigment tests remain positive longer and should not be used for determining when to stop treatment.