CICM SAQ 2016.1 Q3

a) List the factors determining the severity of electrical burn injuries. (30% Marks)

• Type of circuit – AC current worse than DC
• Duration of exposure
• Resistance of tissues : higher the resistance greater the thermal energy produced and
  greater the damage to the tissues
• Voltage: > 1000 V is high voltage and causes greater tissue damage.
• Current
• Pathway of current: affects the part of the body that is damaged

b) List the potential causes of poor lung compliance in a patient who is receiving invasive mechanical ventilation post high-voltage electrical injury. (40% Marks)

• Chest compartment syndrome due to circumferential trunk burns,
• Tight burns dressing on the chest
• Pulmonary oedema due to cardiac involvement
• Pulmonary aspiration
• Lung contusions due to trauma associated with incident
• Abdominal compartment syndrome
• Undersedation/ventilator dysynchrony

c) A patient who has suffered a high-voltage electrical injury is noted on day 2 to have dark coloured urine and a creatine kinase (CK) that is elevated at 32 000 U/L. How will you manage this clinical problem? (30% marks)

• The patient has rhabdomyolysis.
• Examine the patient to rule out compartment syndrome.
  • Surgical opinion and fasciotomy should be considered early
• Prevention of AKI
  • Correction of volume depletion: if present rigorous fluid repletion until it is clear
    from sequential laboratory values that the plasma CK level is stable and not
    increasing
  • Prevention of intratubular cast formation- a forced alkaline diuresis, in which the
    urine pH is raised to above 6.5, may diminish the renal toxicity of haem
    proteins.
  • Diuresis with mannitol can be considered – currently no evidence
• Treatment of Established Renal Failure:
  • CRRT