7. Skin
• Superficial to full-thickness burn
• Findings underestimate the internal thermal
damage !
• characteristic kissing burn - at flexor creases
or others eg. Blisters
8. Bone
• Bone has highest resistance = highest heat
production.
• Destruction of bone matrix (necrosis) + deep
tissues and organs surrounding long bones
• Bone fractures d.t. Fall / Repeated sever muscles
contraction
– Mainly in UL long bones & Vertebrae
• X-ray cervical spine to exclude fractures
especially in comatose patients is MANDATORY
9. Muscles
• Rhabdomyolysis + AKI
• Acute Compartment Syndrome
– Limb swelling + sever pain not related to degree of physical
findings
– Loss of pulsation is a late non-reliable sign for the early
detection of ACS
10. Neuro
• Central & Peripheral
• Include: Loss consciousness, weakness,
paralysis, resp. depression , sensory,
autonomic & memory disturbance
• Usually Transient
• May present after months of electric shock !
(usually as Spinal Cord injury with LMNL
presentation)
11. Cardiac
• Arrhythmias (15%)
– Mostly present shortly after the shock with :
• Asystole (DC / Lightning)
• VF (AC) (most common fatal cause)
– Other arrhythmias : Atrial arrhythmias, BBB, 1st &
2nd degree HB
– Delayed VF may occur d.t prolonged Resp.
Paralysis & hypoxia
– Delayed arrhythmias is generally not common
12. Cardiac
• Myocardial affection
– Generaly not common
– Contusion
– Infarction (rare)
– Due to direct electric injury or Coronary spasm
13. Cardiac
• ** Arrhythmias
= with horizontal currents (hand to hand)
• ** Myocardial damage
= with vertical currents (head to foot)
17. GIT
• Not commonly affected
• May present with P. Ileus / Vascular injury &
Ischemia
• Stress ulcer is common = need prophylactic
therapy
18. Eye
• Dilated fixed or asymmetric pupils (autonomic
dysfunction)
• Catarct (delayed days up to two years after
the electric shock)
• Haemorrhage : Hyphema (anterior) , Vitreous
Haemorrhage (posterior)
• Optic nerve affection
25. Treatment
• Fluid resuscitation
– Aggressive replacement if soft tissue injury
– Prevent Heme pigment-induced AKI
– Administer fluids till
• Normal blood pressure
• UOP ( 0.5 - 1 mL/kg/h if +ve Myoglobin // 1-2 mL/kg/h if -ve Myoglobin)
• CK < 5000 U/L
• negative urine for hematuria
– Not estimated from skin injury degree (Parkland formula)
– Normal Saline = best solution
– Monitor K level (released from damaged muscles)
– Over correction may lead to Abdominal Compartment Syndrome
27. Treatment
• Mannitol
– Osmotic Diuresis to maintain UOP & prevent heme pigment deposition
– 1gm/kg/day
– Contraindicated if Oliguria is present
– Stopped if target UOP not reached with rising plasma osmolarity (may
complicate with hyper-osmolarity / Hyperkalemia)
• Bicarbonate
– Urine alkalization induced diuresis
– Prevent heme deposition
– Give only if :
• PH < 7.5
• HCO3 < 30
• No sever hypocalcemia
– Stopped after 4-6 hours if urine PH not rising above 6.5 or if
hyperCalcemia is present
28. Treatment
• Both Mannitol & Bicarb have questionable effect
– May be used together if CK > 30,000
• Loop Diuretics
– May worsen the case (Calcinuria + Ca deposition)
• Once AKI established
– No specific ttt
– Only stabilization
– Dialysis may be indicated
29. Treatment
• Surgical : Fasciotomy
– in Compartment syndrome = diagnostic &
therapeutic role