Beruflich Dokumente
Kultur Dokumente
Electrical injury differs substantially from thermal injury in that most electrical
injuries are not immediately appar ent. Electrical current can enter the body at one
point, travel through tissues that offer the least resistance (muscle, nerve, vascular
structures), and exit at a ground ing point, often the feet. The skin offers a high
resistance to electrical current and is usually spared. The internal injury is thermal
in nature, resulting from the conduc tance of current through the affected
segment. Low voltage injuries behave more like thermal injuries, and the effects
are local. These are treated with local wound care similar to that for thermal
injuries. Highvoltage injuries can cause extensive muscle and nerve damage,
cardiac arrhythmia, and central and peripheral nervous system injury.
The physical signs of electrical injury include small thermal injury at the entry and
exit sites. Cardiac arrhyth mia is variably present and should be treated according
to Advanced Cardiac Life Support protocols. The heat generated by current
conduction can cause extensive myonecrosis with subsequent release of
myoglobin. The myoglobin then precipitates in the renal tubules, causing renal
failure. Neurologic manifestations include
encephalopathy, aphasia, hemiplegia, and peripheral nerve destruction. A unique
late complication is the devel opment of cataracts, which can be treated
accordingly.
Early, aggressive debridement is needed, with particu lar attention to deep muscle
compartments, which may have sustained substantial damage. Questionably viable
tissue can be reexplored in 48 hours. A careful evalua tion for compartment
syndrome must be undertaken, with early escharotomy or fasciotomy as needed.
Alka line diuresis with mannitol and sodium bicarbonate solu tion renders the
myoglobin pigments more soluble. Urine output should be maintained near
2mL/kg/hr. Invasive monitoring (central venous pressure [CVP], pulmonary
arterial [PA] catheter) may be required to ensure optimal volume status.
The initial evaluation should include electrocardio gram, arrhythmia recognition
and treatment, and rhythm monitoring as indicated. Frequent neurologic checks
should be made during hospitalization as varying degrees of encephalopathy or
peripheral nerve injury manifest. A thorough assessment for associated trauma
should be undertaken, because highvoltage injuries (e.g., power line injuries) are
often associated with falls.