As you start work, you wonder where your end-of shift colleague is. The question is answered when the curtain for bay 2 is pulled back and you see her intubating a young man. She tells you he arrived by ambulance for “burn care.” He fell 12 feet to the ground after his mop pole touched a power line above the semi-trailer he was cleaning. There are minor burns to his hands and chest wall, but more worrisome is the pink fluid draining from his ears and nose. As you assess the patient, you wonder how best to prioritize the patient’s workup…
The pink fluid draining from the nose and ears of your patient who fell off the semi-trailer was caused by the patient having sustained a basilar skull fracture from the fall. The burns on his hand and chest most likely represented the entrance and exit of the electrical discharge and the fall possibly due to a transient dysrhythmia. Fortunately, his vital signs were stable and there was no evidence of myocardial damage. Instead, the leaking cerebrospinal fluid was the biggest concern, and you were reminded of the importance of a careful secondary survey in patients with electrical injuries. The patient was admitted to the neurosurgical ICU, remained stable, and had an uneventful recovery.