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History
▪ A 45 year-old man was found unconscious on ground.
▪He was using a electric hand drill before.
▪No convulsion was noticed by his colleagues.
▪No period of cardiac arrest was documented.
▪He regained consciousness in ambulance.
Differential diagnosis
▪CVS▪Cardiac arrhythmia▪ Ischaemic heart disease
▪CNS▪Syncope▪Epilepsy
▪ Endocrine▪Hypoglycaemia▪Electrolyte disturbance▪Addison’s disease
▪Others▪Electrocution▪Drug effect▪Substance abuse
History
▪ A 45 year-old man was found unconscious on ground.
▪He was using a electric hand drill before.
▪No convulsion was noticed by his colleagues.
▪No period of cardiac arrest was documented.
▪He regained consciousness in ambulance.
Assessment
▪ Charred mark was noted at right palm
▪ No other external wound
▪ Heart sound was normal
▪ No neurological deficit was noted
▪ Mild tenderness was noted over both loin region
Management Priority
▪ Airway with cervical protection
▪ Breathing
▪ Circulation
▪ Deficit and Disability
▪ Exposure
▪ Fluid Management and Foley
▪ Gastric tube (if indicated)
What Investigations will you order?
Baseline Investigations▪Chest X-ray
▪ Electrocardiogram
▪CBP, electrolytes, CPK, troponin I
What additional test you would like to order to guide your fluid management?
▪ Urine for myoglobin
▪ The fluid regime should be adjusted so that the urine output is maintained at least 100mL per hour
▪ Mannitol 25g ivi may be considered if the urine output is still not satisfactory
Myoglobinuria
Electrical Burn
▪ Deep muscle necrosis and rhabdomyolysis causing acute renal failure may occur in relatively normal looking skin.
▪ Severe electric shock may cause fatal dysrhythmia
▪ 110V AC can produce ventricular fibrillation
▪ Involuntary muscle contractions forceful to cause fractures or joint dislocations
▪ Can induce respiratory arrest and seizures
Lightning injury
▪ >10,000,000V DC in 1-3ms
▪ Mainly involve skin giving rise to Lichtenberg figures
▪ Neurologically ▪ unconscious/ paralysis/ paraesthesia/ seizure
▪ Auditory ▪ tinnitus/vertigo/TM rupture
▪ Cardiac ▪ ECG arrhythmia/MI like pattern
Wound Management
▪ Fluid inside blister is sterile
▪ It will be re-absorbed by body with time
▪ Aspirate blister if it is too tense or too large
▪ Do not deroof the blister
Wound Management
▪ Promote wound healing
▪ Keep clean
▪ Prevent infection
▪ Keep dry but not too dry
▪Minimize pain ( each time of change dressing)
Wound Management
▪ 1st degree burn -> lotion would be enough
▪ Superficial partial thickness▪ Simple wound dressing or various dressing
materials
▪ Possible dressing methods:▪ Daily OPD dressing till fully granulated▪No topical agent is required
▪ Special dressing e.g. Hydrocolloid dressing▪Keep intact and renew every 2 to 3 days
Dressing materials
▪ Some dressing aim to keep the wound intact till totally healed
▪ Some allow exudate to be absorbed without change of dressing
▪ Some aim to keep wound dry and inhibit bacterial growth
▪ Silver sulphadiazine is out of favor nowadays
▪ Most burn wound do not require antibiotic
Wound Management
▪For deep partial thickness▪ May need excision and skin graft / flap over
functionally or cosmetically important area
▪3rd/4th degree burn▪ Skin graft▪ Skin flap▪ Reconstruction surgery