The treatment of patients with high-voltage electric injury differs from that of patients with conventional thermal injury with respect to the need for:

A. Fasciotomy

B. Hemodialysis

C. Amputation.

E. Prehospital cardiopulmonary resuscitation.

DISCUSSION: Both lightning injury and contact with electric current can induce cardiopulmonary arrest due to either asystole or fibrillation. Cardiopulmonary resuscitation must be initiated at the site of injury if cardiac arrest is present. Cardiac arrhythmias may also occur following resuscitation, necessitating electrocardiographic (ECG) monitoring for at least 48 hours following injury in patients with a history of loss of consciousness or an abnormal ECG. Tissue damage and tissue destruction beneath the investing fascia can result in the formation of edema that increases muscle compartment pressure to a level that necessitates fasciotomy (> 30 mm. Hg). The current flow in a limb in contact with high-voltage current can be so great as to damage even the periosseous muscles and make amputation necessary. Liberation of hemochromogens as a consequence of deep tissue injury is associated with an increased incidence of acute renal failure necessitating hemodialysis. Electric injury does not influence the need for monitoring by pulse oximetry, and in fact the destruction of deep tissue in a limb may preclude application of the pulse oximeter to that extremity.