eMedicine Specialties > Trauma > Multiorgan Trauma Management

Electrical Injuries: Workup

Author: Brian James Daley, MD, MBA, FACS, Associate Program Director, Professor, Department of Surgery, Division of Trauma and Critical Care, University of Tennessee School of Medicine
Coauthor(s): Jose Fernando Aycinena, MD, Staff Physician, Department of General Surgery, University of Tennessee Graduate School of Medicine; Ali Farouk Mallat, MD, Surgical Critical Care Fellow, Department of General Surgery, University of Michigan Health System
Contributor Information and Disclosures

Updated: Jun 12, 2008

Workup

Laboratory Studies

  • Indicated lab studies include complete blood cell count, serum electrolyte levels, liver function tests, BUN, creatinine levels, and urinalysis with urine for myoglobin. Determination of creatine kinase (CK) is important to develop an appropriate management plan.
  • More severely injured patients who require surgery may need blood typing or cross matching, prothrombin time, and activated partial thromboplastin time studies.

Imaging Studies

  • The need for imaging studies is dictated by other elements of the history or by patient complaints. Violent tetanic contractions may lead to focal bone fractures; the latter can also result from falls, especially in the context of lightning injury or high-voltage DC current.
  • Perform cervical spine, chest, and pelvis radiographs on any victim who was previously unconscious. Also, obtain appropriate extremity films in victims with obvious extremity injuries.

Other Tests

  • Record ECG readings in all patients.
  • If smoke inhalation is suspected by history, then arterial blood gases (ABGs) and pulse oximetry may be indicated.

Diagnostic Procedures

  • The development of increased myofascial compartment pressures is of great concern. If this is suspected, each compartment must be measured. If signs and symptoms of compartment syndrome exist, decompression is necessary. The hallmark of compartment syndrome is pain with passive motion in the compartment containing the muscle groups responsible for that motion. Characteristically, the pain is unrelenting and may appear out of proportion to the visible injury. Patients may experience paresthesia, hypoesthesia, or decreased motor function. Remember that loss of pulses is a late sign of compartment syndrome.

More on Electrical Injuries

Overview: Electrical Injuries
Workup: Electrical Injuries
Treatment: Electrical Injuries
Follow-up: Electrical Injuries
References
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References

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  9. Fish R. Electric shock, Part I: Physics and pathophysiology. J Emerg Med. May-Jun 1993;11(3):309-12. [Medline].

  10. Fish R. Electric shock, Part II: Nature and mechanisms of injury. J Emerg Med. Jul-Aug 1993;11(4):457-62. [Medline].

  11. Fontanarosa PB. Electrical shock and lightning strike. Ann Emerg Med. Feb 1993;22(2 Pt 2):378-87. [Medline].

  12. Jost WH, Schönrock LM, Cherington M. Autonomic nervous system dysfunction in lightning and electrical injuries. NeuroRehabilitation. 2005;20(1):19-23. [Medline].

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  15. Leibovici D, Shemer J, Shapira SC. Electrical injuries: current concepts. Injury. Nov 1995;26(9):623-7. [Medline].

  16. Martinez JA, Nguyen T. Electrical injuries. South Med J. Dec 2000;93(12):1165-8. [Medline].

  17. Romero B, Candell-Riera J, Gracia RM, Fernandez MA, Aguadé S, Peracaula R, et al. Myocardial necrosis by electrocution: evaluation of noninvasive methods. J Nucl Med. Feb 1997;38(2):250-1. [Medline].

  18. ten Duis HJ. Acute electrical burns. Semin Neurol. Dec 1995;15(4):381-6. [Medline].

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Further Reading

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Keywords

electrical injury, electric shock, electrocution, electrical shock, electrical burn, electrocution burn, electrical trauma, shock, hit by lightning, lightning trauma, lightning strike, alternating current, AC, direct current, DC, wattage, voltage, Ohm law, Ohm's law, high-voltage injury, high-voltage trauma, burn injury, burn

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Contributor Information and Disclosures

Author

Brian James Daley, MD, MBA, FACS, Associate Program Director, Professor, Department of Surgery, Division of Trauma and Critical Care, University of Tennessee School of Medicine
Brian James Daley, MD, MBA, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Chest Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Association for Surgical Education, Eastern Association for the Surgery of Trauma, Shock Society, Society of Critical Care Medicine, Southeastern Surgical Congress, and Tennessee Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Jose Fernando Aycinena, MD, Staff Physician, Department of General Surgery, University of Tennessee Graduate School of Medicine
Jose Fernando Aycinena, MD is a member of the following medical societies: American College of Surgeons and Tennessee Medical Association
Disclosure: Nothing to disclose.

Ali Farouk Mallat, MD, Surgical Critical Care Fellow, Department of General Surgery, University of Michigan Health System
Ali Farouk Mallat, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, International College of Surgeons US Section, National Arab American Medical Association, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Critical Care Medicine, and Tennessee Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Alex Jacocks, MD, Program Director, Professor, Department of Surgery, University of Oklahoma School of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Robert L Sheridan, MD, Assistant Chief of Staff, Chief of Burn Surgery, Shriners Burns Hospital; Associate Professor of Surgery, Department of Surgery, Division of Trauma and Burns, Massachusetts General Hospital and Harvard Medical School
Robert L Sheridan, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, and American College of Surgeons
Disclosure: Nothing to disclose.

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other; AstraZeneca Grant/research funds Other

 
 
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