Electrical Burn Initial Stabilization
Electrical burns should be managed using an ABCD approach with immediate assessment for life-threatening airway and respiratory compromise and for traumatic injuries. [1] Electric current exposure should be considered associated with internal injury even when cutaneous injury appears small. [2] Patients should be kept warm and reassessed to prevent hypothermia and missed deterioration. [1]
Scene Safety and Immediate First Aid
The power source should be turned off before approaching a casualty to prevent secondary injury. [3] Minor electrical skin burns should be treated as burns after removal of the source of injury. [0]
Diagnostic Evaluation and Monitoring
An ECG should be obtained in electrical burns. [1] Continuous monitoring should include heart rate and blood pressure to detect dysrhythmia or hemodynamic instability. [1] Basic laboratory evaluation should include blood glucose and renal function with group and hold. [1] Blood electrolytes should be checked and corrected when derangements are present. [1]
Admission, Observation, and Disposition
Admission is recommended for patients with chest pain, arrhythmia, abnormal initial ECG, or elevated troponin. [1] Domestic electrocution with no cardiac complaints and a normal ECG is recommended for discharge. [1]
Burn Wound Care and Supportive Management
Burn wound management should include formal assessment of burn depth and total body surface area. [1] Prolonged exposure should be avoided and painful injuries should receive pain management per local practice and available resources. [1]
High-Risk Electrical Injury Complications
Compartment syndrome should be anticipated in electrical injuries, particularly with deep limb burns, circumferential burns, and associated blunt trauma. [1] Compartment syndrome should be suspected when pain is disproportionate to the injury or when paresthesia is present. [1] Rhabdomyolysis and dark urine due to haemochromogenuria should be anticipated in patients with deep tissue damage. [1] A urinary catheter should be inserted to detect earliest urine discoloration and to monitor urine output. [1] If urine pigments appear, infusion rates should be increased to maintain urine output at 1–2 mL/kg/hr. [1]
Fluid and Electrolyte Management
Fluid requirements in electrical injuries can exceed expectations from standard cutaneous burn formulas because of concealed muscle damage and ongoing losses. [1] Electrolyte derangements should be corrected as part of acute management. [1]
Escalation and Referral
Urgent discussion with a burns unit or plastics registrar on call is indicated when there is circumferential burn physiology or respiratory restriction risk. [1] Electrical injury should prompt a low threshold for specialist burn involvement due to risk of cardiac, compartment, and renal complications. [2]
Discharge Safety Considerations
Discharge is recommended for domestic electrocution with no cardiac complaints and a normal ECG. [1] Discharge should not be used when ECG abnormalities, chest pain, arrhythmia, or troponin elevation are present, because admission is recommended. [1]