Question

Mr. J. is a 30-year-old electrical line worker brought to the emergency department by ambulance. Emergency medical service (EMS) personnel report that he was in a cherry picker that came into contact with an overhead 70,000-volt power line. He lost consciousness at the scene and was intubated. On presentation to the ED, Mr. J. is noted to have areas of black charring on his right arm, axilla, and upper thighs.

Questions

1. What are some potential causes of Mr. J.'s loss of consciousness?
2. What are the initial and secondary management priorities for Mr. J.?
3. During the secondary survey, an indwelling urinary catheter is inserted. You notice dark red-brown

urine draining. What is occurring? Describe the appropriate treatment(s) and rationale for

implementation.
4. During wound assessment, you note moist red and dry, black, charred-appearing areas of the inner

aspect of Mr. J.’s right hand, right arm, right axilla, and bilateral anterior thighs. What is the depth and extent (%TBSA) of his burn wounds? How does a high-voltage electrical injury impact your calculation of burn wound extent?

5. What type of wound care and/or surgical treatment should be expected during the resuscitative phase and later in the acute care phase?

6. Mr. J. weighs 82 kg. What is his estimated fluid requirement during the first 24 hours? Are there any special considerations and assessments that should be made?

7. Name several short- and long-term sequelae and complications that can develop with electrical burn injuries.

8. In addition to nurses and physicians, what multidisciplinary team members should be involved in Mr. J.’s care? When and why should they be involved?

9. What type and route of pain medication should be administered to Mr. J.? 10. What kind of nutrition plan should be implemented for Mr. J.?

Answer 1

1. Unconscious:

The cause for loss of conscious are electric burns with cardiogenic shock.

2. Priority:

1. Establish airway

2.prober breathing

3. Adequate circulation

4. Fluid resuscitation

5. Pain management

3. That indicates bleeding and start continuous bladder irrigation

4. Burn calculations

Right hand = 9% and anterior thighs= 9%, totally 18%.

5.Surgical treatment

Skin grafting can be performed.

6. Fluid calculation:

4ml*% of TBS* kg body weight

4* 18* 82 = 5904ml or around 5 litre 04ml

7. Short term complaints - Injuries to skin, muscles, bone.

Long term complaints- Fractures, morbidity

8. Yes, like Respiratory therapist, physiotherapist, occupational therapist, dietician etc

9. Pain medication around a clock analgesia, PCA analgesia through intra venous route.

10. Nutrition: vitamin c and protein rich diet to promote wounds healing.