9 Electrical Injury, Chemical Burns, and Cold Injury “Frostbite” |
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System |
Sequelae |
Management |
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Renal [4, 5, 22, 23] |
Myoglobinuria |
Increase fluid resuscitation to maintain a |
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urine output of 1 ml/kg/h |
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Acute tubular necrosis |
Some controversy regarding alkalinization |
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(with sodium bicarbonate infusion) of urine |
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and forced diuresis (with mannitol) |
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Musculoskeletal [4, 5, 10, 13, 16, 20, 21]
Muscle necrosis |
Compartment decompression as necessary: |
Compartment syndrome |
Progressive neurologic dysfunction |
Rhabdomyolysis |
Increased compartment pressure |
Fracture |
Vascular compromise |
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Clinical deterioration from myonecrosis |
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Excision of all nonviable tissue |
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Might require amputation |
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Manage orthopedic injuries with appropri- |
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ate consultation |
Table 9.3 Common neurological |
Neurologic |
Numbness (82 %) |
and psychological sequelae |
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Paresthesias (63 %) |
of LVEIa |
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Pain (54 %) |
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Headache (45 %) |
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Weakness (45 %) |
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Psychologic |
Anxiety (54 %) |
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PTSD (54 %) |
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Poor concentration (54 %) |
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aAdapted from Singerman et al. [28] |
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9.2Chemical Burns
Chemical burns represent a small portion of cutaneous burns (reported from 3 to 10 %); however, as with electrical injuries, they have dire consequences [30–33]. There are thousands of different chemicals in everyday use, and this section briefly discusses the general principles in the management of these injuries. In general, the severity of the chemical burn is dependent on the concentration, quantity of the agent, the duration of contact, the depth of penetration, and the mechanism of its action [30, 31]. Table 9.4 summarizes the different classes of chemicals and the mechanism by which they cause tissue damage.
The general principles in the treatment of chemical burns begin as with all trauma with ABCDE of primary trauma survey. The specific measures for chemical burns involve the removal of the inciting agent, treatment of systemic toxicity, specific antidotes if necessary, and local wound care [30]. The general principles for the management of chemical burns are summarized in Table 9.5.