Disposition

Disposition depends on the patient’s clinical status and voltage exposure. All high voltage injuries should be transferred and treated at a regional burn center.¹⁰ Cardiac monitoring and observation of at least eight hours should be considered for a patient with an electrical injury and isolated syncope.⁵ Otherwise, if a patient’s ECG is normal, a low voltage exposure, and the clinical examination is without any significant trauma, burns, or electroporation injuries, the patient may be safely discharged with follow-up as warranted.

In our case, the patient had a CT of the head, cervical spine, and chest, abdomen, and pelvis with intravenous contrast demonstrated a C2, C7 compression fracture with significant bowel edema (Figure 4), and was taken to the operating room for left arm disarticulation, left below knee amputation and right above knee amputation. His ECG was unremarkable. In the operating room, there was minimal urinary output and the bladder pressures were 35 mmHg under sedation and analgesia. Subsequently, a decompressive laparotomy was performed for abdominal compartment syndrome. He underwent continuous renal replacement therapy (CRRT) with complications of acute respiratory distress syndrome and need for left scapular disarticulation, and transitioned to comfort care by his next of kin on hospital day five.

Dr. Koo is faculty and an emergency physician at MedStar Washington Hospital Center in Washington, D.C., and St. Mary’s Hospital in Leonardtown, Maryland.

Dr. McCollum is the director of teaching and learning in the department of emergency medicine at Augusta University in Augusta, Georgia.

References

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