CICM SAQ 2016.1 Q3

Question

With regards to high-voltage electrical injuries:

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

Answer

Answer and interpretation

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

Pass rate: 85%

Highest mark: 7.25


Exams LITFL ACEM 700

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Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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