Thursday, November 13, 2014

A 32-year-old man sustained an electric shock while working on a high-voltage power line

A 32-year-old man sustained an electric shock while working on a high-voltage power line. He is awake, alert, and oriented and has normal vital signs but complains of paresthesias in the affected arm. Your management includes:

a. Symptomatic treatment, discharge.
b. Analgesia, observation for 6 hours, discharge.
c. Analgesia, observation for 6 hours on a cardiac monitor, discharge.
d. Analgesia, observation for 6 hours on a cardiac monitor, check urine for myoglobin, discharge.
e. Analgesia, cardiac monitoring, CBC, basic metabolic panel, total CK, EKG, admission to a monitored bed.



The answer is e. High-voltage can be defined as greater than 600 V. Patients with low-voltage injuries and evidence of complications such as rhabdomyolysis should be admitted. Those with high-voltage injuries are at risk for serious and sometimes delayed complications such as cardiac arrhythmias, arterial thrombosis, compartment syndromes, rhabdomyolysis, and nerve damage. Because of these risks, all patients with high-voltage injuries should be admitted to the hospital.

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