CURRENT Essentials of Critical Care.pdf

248 Current Essentials of Critical Care■■■Electrical Shock & Lightning InjuryEssentials of Diagnosis• Burns: partial or full thickness skin damage• Household current shock: transiently unconscious, headache,cramps, fatigue, paralysis, rhabdomyolysis, atrial or ventricularfibrillation, nonspecific ST-T ECG changes• Lightning strike: para- or quadriplegia, autonomic instability,hypertension, nonspecific ST-T ECG changes; blunt trauma dueto falls; burns typically superficial• Degree of injury depends on conducted current of electricity• Alternating current (household) more dangerous than direct current(lightning); high voltage injury defined as 1000 voltsDifferential Diagnosis• Cardiac arrhythmia• Thermal or chemical burns• Blunt traumatic injury• Toxin or smoke inhalationTreatment• Intubation and mechanical ventilation for respiratory compromise• Fluid resuscitation• Most immediate risk from cardiac arrhythmia, particularly ifelectric shock passed through the thorax; most arrhythmias selflimited, but may require antiarrhythmic drugs• Local care for skin wounds; transfer to burn unit if extensiveburns• Monitor creatine kinase levels for rhabdomyolysis; if present,consider alkalinization of urine■ PearlLightning generates massive peak direct current of 20,000–40,000 amperesfor 1–3 microseconds. Despite this, patients surviving the immediateevent typically have few complications and often only requireobservation.ReferenceKoumbourlis AC: Electrical injuries. Crit Care Med 2002;30(11 Suppl):S424.[PMID: 12528784]