Electrical Injuries Workup

Updated: Feb 08, 2017
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Workup

Laboratory Studies

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  • 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.

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Imaging Studies

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  • 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.

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Other Tests

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  • Record ECG readings in all patients.

  • If smoke inhalation is suspected by history, then arterial blood gases (ABGs) and pulse oximetry may be indicated.

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Diagnostic Procedures

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  • 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.

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