Electrical Conduction Injury - Initial Management of Adult and Pediatric Patient

exp date isn't null, but text field is

1. All patients with electrical injury will receive a 12 lead electrocardiogram (ECG) and continuous cardiac monitoring in the ED.
2. Creatinine kinase (CK) levels should also be measured. CK levels may not be diagnostic in low voltage injuries but can assess the severity of injury and risk for rhabdomyolysis in patients with high voltage exposure, prehospital cardiac arrest, full thickness burns, and compartment syndrome (1)
3. If the pathway of current is suspected across the chest /thorax troponin levels should also be measured. Consider checking urine myoglobin.
4. All patients with a history of loss of consciousness, dysrhythrnia/ECG changes before or after admission, or elevated enzyme levels should be admitted for continuous cardiac monitoring. Cardiac monitoring to continue for 24 hours after resolution of ECG changes/dysrhythmia.
5. Patients with low voltage injury, no ECG abnormalities, no history of loss of consciousness, cardiac arrest, or abnormal rate or rhythm, and no other indications for admission may be discharged home from the ED.
6. Indications for admission
   1. Dysrhythmia or EKG changes
   2. High voltage injury
   3. Loss of consciousness
   4. Elevated CK or troponin levels
   5. Burn injuries requiring wound care/fluid resuscitation
   6. Neurologic changes in peripheral extremities or Paralysis or mummified extremity
   7. Loss of peripheral pulse
   8. Flexor surface contact injury (antecubial, axillary, inguinal or popliteal burns)
   9. Myoglobinuria (red or black urine)
   10. Pediatric patients with oral injury to monitor for labial artery bleeding
   11. Concern for compartment syndrome/extremity monitoring in patients following high voltage injury
7. Resuscitation: prompt initiation of fluid resuscitation to maintain a high urine volume is important whenhemochromogens are evident in the urine. Resuscitation based on visible surface area burns may be inadequate.
   1. Insert a urinary catheter
   2. Infuse additional LR at a rate sufficient to maintain a urine output of 75-100 mL per hour in an adult or 1 mL/kg/hour in a child
   3. If there is evidence of hemochromogens such as myoglobin, the urine output should be maintained between 75-100 mL per hour until the urine grossly clears.
   4. Routine alkalization of the urine is not indicated.