Clinical Pathways
Clinical Pathways
High voltage (>1000 V) or lightning injury
High voltage (>1000 V) or lightning injury

High voltage (>1000 V) or lightning injury

View The Full Pathway

Action

  • Obtain IV access and start isotonic crystalloid fluids
  • Obtain:
    • CBC
    • Glucose
    • Electrolytes
    • BUN
    • Creatinine
    • CK (creatine kinase)
    • UA
    • Urine myoglobin
    • Pregnancy test (if applicable)
  • Place patient on telemetry
  • Obtain imaging indicated per history and physical examination

(Class II)

Decision

Currently at regional burn center?

Yes

  • Monitor for adequate fluid resuscitation (UOP >1 mL/kg/hr)
  • Administer pain control
  • Consult any required specialists

(Class II)

No

  • If meets referral criteria, transfer to regional burn center accepting pediatric patients
  • Monitor for adequate fluid resuscitation (UOP >1 mL/kg/hr)
  • Perform serial neurovascular examinations
  • Administer pain control
  • Cover burns with a clean, dry sheet

(Class II)

Background

Lightning Injuries

Lightning injuries pose unique and substantial risks, with a mortality rate of 10% to 30%.3^3 Lightning strikes can cause injury by multiple mechanisms.33,34^{33,34} (See Table 4.) Signs and symptoms can present immediately or be delayed years following exposure.3,67,68^{3,67,68} (See Table 5.) Dilated and unreactive pupils can occur due to electrical effect on the nervous system, so this finding should not be used to guide clinical decision-making.3,30^{3,30}

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Burn Center Referrals

The American Burn Association (ABA) recommends that any patient with a burn from an electrical injury should be referred; however, if it is a minimal injury due to low-voltage exposure, it may be helpful to discuss with the general surgery team to help determine disposition, as the patient may be safely discharged. Prior to transfer, the patient should be stabilized; burns covered with a dry, clean dressing or sheet; with the patient kept warm. There is no need to clean wounds, since they will undergo formal evaluation at the burn center. Elevate any extremity to help prevent burn wound edema.42^{42}

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References
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