Summary
Definition
History and exam
Key diagnostic factors
- loss of consciousness
- prehospital CPR or defibrillation
- tachycardia
- hypotension
- low Glasgow Coma Scale score
- burns
- physical injuries
Other diagnostic factors
- diminished peripheral pulses and poor capillary refill
- low core body temperature
- confusion
- paralysis
Risk factors
- age <6 years
- construction industry workers
- male sex
- participation in outdoor sports
Diagnostic tests
1st tests to order
- ECG
- CBC
- electrolytes
- LFTs
- coagulation studies
- creatine kinase
- urine myoglobin
- cardiac enzymes (CK-MB and troponin)
- toxicology screen
- chest x-ray
Tests to consider
- plain x-rays
- head CT
- head MRI
- compartment pressure measurements
Treatment algorithm
all patients
Contributors
Authors
Baljit Dheansa, MBBS, FRCS, MSc, FRCS (Plast)
Consultant Burns, Plastic & Reconstructive Surgeon
Honorary Senior Lecturer
Queen Victoria Hospital NHS Foundation Trust
West Sussex
UK
Disclosures
BD is the Chair of the Data Monitoring Board of a trial studying enzymatic debridement of burns, and Chair of the Steering Committee of a trial studying LASER treatment of scars. He is also an expert witness in medicolegal cases involving burns, and regularly teaches on burn injury to students and health professionals.
Ahmed Hagiga, MBBCh, MRCS, MSc
Plastic Surgery Registrar
Plastic Surgery Department
Queen Victoria Hospital NHS Foundation Trust
West Sussex
UK
Disclosures
AH declares that he has no competing interests.
Acknowledgements
Mr Dheansa and Mr Hagiga would like to gratefully acknowledge Dr Juan Enrique Berner and Dr T Grant Phillips, previous contributors to this topic.
Disclosures
JEB and TGP declare that they have no competing interests.
Peer reviewers
Stephen J. Ritz, DO
UPMC St. Margaret Family Medicine Residency and Faculty Development Fellowship
Osteopathic Family Practice/Rotating Internship Program
Pittsburgh
PA
Disclosures
SJR declares that he has no competing interests.
Catalina C. Ionita, MD
Assistant Professor of Neurology and Neurosurgery
SUNY
Buffalo
NY
Disclosures
CCI declares that she has no competing interests.
Bernd Hartmann, MD
Chief Physician
Centre for Severe Burns Injuries with Plastic Surgery
Unfallkrankenhaus Berlin (Trauma Hospital Berlin)
Berlin
Germany
Disclosures
BH declares that he has no competing interests.
References
Key articles
Spies C, Trohman RG. Narrative review: Electrocution and life-threatening electrical injuries. Ann Intern Med. 2006 Oct 3;145(7):531-7. Abstract
Davis C, Engeln A, Johnson E, et al. Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update. Wilderness Environ Med. 2014 Dec;25(4):S86-95.Full text Abstract
American Heart Association. Part 10.9: electric shock and lightning strikes. Circulation. 2005 Dec 13;112(24):IV-154-5.Full text
Arnoldo B, Klein M, Gibran, NS. Practice guidelines for the management of electrical injuries. J Burn Care Res. 2006 Jul-Aug;27(4):439-47. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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