Electrical Injuries in the Emergency Department: An Evidence-Based Review (Trauma CME) -
Publication Date: November 2018 (Volume 20, Number 11)
CME: This issue includes 4 AMA PRA Category 1 Credits™; 4 ACEP Category I credits; 4 AAFP Prescribed credits; and 4 AOA Category 2 A or 2B CME credits. Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits, subject to your state and institutional approval.
Joshua Gentges, DO
Associate Professor, Research Director, Department of Emergency Medicine, Oklahoma University School of Community Medicine, the University of Oklahoma, Tulsa, OK
Christoph Schieche, MD
Assistant Professor, Department of Emergency Medicine, Oklahoma University School of Community Medicine, the University of Oklahoma, Tulsa, OK
Kelly P. O’Keefe, MD, FACEP
Professor of Clinical Sciences, Program Director, Emergency Medicine Residency, Florida State University College of Medicine, Sarasota Memorial Hospital, Sarasota, FL
Mark Silverberg, MD, FACEP
Associate Professor, Associate Residency Director, Kings County Hospital, SUNY Downstate Department of Emergency Medicine, Brooklyn, NY
Electrical injuries can be caused by exposure to current from low-voltage and high-voltage sources as well as lightning strikes, and the circumstances of the exposure will dictate management strategies. Human tissues have varying resistance characteristics and susceptibility to damage, so injuries may be thermal, electrical, and/or mechanical, potentially causing burns, thrombosis, tetany, falls, and blast injury. This issue reviews the types of trauma seen with electrical injury and how body systems can be affected by occult or delayed effects, and the optimal evidence-based resuscitation and management strategies associated with each.
Excerpt From This Issue
You arrive to work at the regional burn center’s ED, and a nurse pulls you into resuscitation bay 1. Paramedics have presented with a thirtysomething man in cardiac arrest. He had been helping his daughter build a curious device called a Jacob’s ladder—a homemade machine that creates an electrical arc. His presenting rhythm was asystole but by the time of his arrival in the ED, he is in ventricular fibrillation. You wonder if his cardiac arrest is related to the device, and what your next best step is...
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...
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