Medication Summary
Hydration is key to reducing the morbidity in severe burns. If there is significant muscle damage with myoglobinuria, fluid resuscitation is first-line treatment. Osmotic diuretics and/or alkalinizing agents may be used for myoglobinuria, but the effectiveness of these medications to prevent acute kidney injury the subject of ongoing debate. [38, 39]
Fluids
Class Summary
Extravascular pooling of fluids through damaged endothelium leads to vascular hypovolemia and hypotension. Patients require fluid resuscitation with normal saline or lactated ringer.
Lactated Ringer solution
Lactated Ringer solution is essentially isotonic and has volume-restorative properties.
Osmotic diuretics
Class Summary
Osmotic diuretics assist the kidneys in excreting myoglobin if present. They can help avoid acute renal failure in patients with significant myoglobinuria.
Mannitol (Osmitrol)
Mannitol is an osmotic diuretic that is not metabolized significantly and that passes through glomerulus without being reabsorbed by the kidney.
Loop diuretics
Class Summary
These agents decrease plasma volume and edema by causing diuresis.
Furosemide (Lasix)
The proposed mechanisms for furosemide in lowering intracranial pressure include (1) lowering cerebral sodium uptake, (2) affecting water transport into astroglial cells by inhibiting cellular membrane cation-chloride pump, and (3) decreasing CSF production by inhibiting carbonic anhydrase. The dose must be individualized to patient.
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Arcing electrical burns through the shoe around the rubber sole. High-voltage (7600 V) alternating current nominal. Note cratering.
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Contact electrical burn. This was the ground of a 120-V alternating current nominal circuit. Note vesicle with surrounding erythema. Note thermal and contact electrical burns cannot be distinguished easily.
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Contact electrical burns, 120-V alternating current nominal. The right knee was the energized side, and the left was ground. These are contact burns and are difficult to distinguish from thermal burns. Note entrance and exit are not viable concepts in alternating current.
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Electrical burns to the hand.
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Electrical burns to the foot.
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High-voltage electrical burns to the chest.
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Superficial electrical burns to the knees (flash/ferning).
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Energized site of low-voltage electrical burn in a 50-year-old electrician.
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Grounded sites of high-voltage injury on the chest of a 16-year-old boy who climbed up an electric pole.
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Energized site of the high-voltage injury depicted in Media File 9 (16-year-old boy who climbed up an electric pole).
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Entrance site of a low-voltage injury.
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Grounded sites of a low-voltage injury in a 33-year-old male suicide patient.
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Grounded site of a low-voltage injury in the same 33-year-old male patient depicted in Media File 12.
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Grounded sites of low-voltage injury on the feet.
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A histologic picture of an electrical burn showing elongated pyknotic keratinocyte nuclei with vertical streaming and homogenization of the dermal collagen (40X). Courtesy of Elizabeth Satter, MD.
Tables
Effect |
Current (milliamps) |
Tingling sensation/perception |
1-4 |
Let-go current – Children |
3-4 |
Let-go current - Women |
6-8 |
Let-go current – Men |
7-9 |
Skeletal muscle tetany |
16-20 |
Respiratory muscle paralysis |
20-50 |
Ventricular fibrillation |
50-120 |
