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Table 109.3

Management after Electrical Injury

Complication of electrical injuryComment/management
Burns

Seek advice on management from burns unit

Patients with burns above the neck may have associated airway/lung injury with respiratory failure

Musculoskeletal injuries

Refer to plastic/orthopedic surgeon

Fractures, spinal injury, periosteal burns, destruction of bone matrix and osteonecrosis may occur

Deep electrothermal tissue injury may result in oedema and compartment syndrome

Neurological and ocular injury

Manifestations of electrical injury include paralysis, autonomic dysfunction, secondary complications such as head or spinal injury, ruptured eardrum, hyphema and vitreous haemorrhage

Arrange CT/MRI if there is evidence of neurological/ocular injury

Cardiac injury

Cardiac contusion may occur

Incidence of arrhythmia following electrical injury is 15%, most benign and transient (atrial arrhythmias, first and second-degree atrioventricular block and bundle branch block)

Monitor ECG; request echocardiography if plasma troponin is raised or if there is significant arrhythmia

Acute kidney injury

May occur due to hypovolaemia (from extravasation of fluid) and rhabdomyolysis (from muscle injury) (Appendix 25.1)

Fluid resuscitation

See Chapter 25 for management of acute kidney injury

Injury to abdominalDamage is uncommon
visceraRefer to general surgeon if suspected