A patient sustains a high voltage electrical injury to the upper extremity. Which of the following statement(s) is/are true concerning peripheral perfusion to the injured arm?

b. Physical signs of diminished blood flow include a progressive increase in the extremity’s consistency and a decrease in distal temperature

d. An immediate fasciotomy performed in the operating room may be necessary

Regular assessment and documentation of peripheral perfusion is crucial during the first post-injury days. Blood flow can be compromised by constricting circumferential eschar as subeschar tissues become progressively edematous or by progressive intracompartmental edema in patients with electrical or deep thermal burns. Both are detected by the development of a progressive increase in the extremity’s consistency and a decrease in its distal temperature. Pulsatile doppler signals in the lower pressure distal vasculature, such as the plantar arch and digital vessels, should be documented hourly. The loss of pulsatile doppler signals is consistent with an increase in tissue pressure if intravascular volume is adequate. Although lesser voltages may cause local destructive injuries without systemic sequelae, patients exposed to higher voltage (> 1000 volts), present with a combination of deep tissue injuries secondary to the passage of current, locally destructive entrance and exit wounds, and other local and systemic effects. Compartmental pressure elevation, secondary to edema of injured muscle, can result in additional ischemic injury if compartments are not promptly released by fasciotomy.