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Burn resuscitation — MCCQE Part 1 MCQ

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HardTraumaBurn resuscitationMCCQE Part 1

A 40-year-old electrician sustains a high-voltage injury. He has a small hand entry burn and foot exit burn, dark urine and thigh tenderness despite little visible skin injury. What is the most appropriate initial evaluation and management?

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Correct answer: A — Cardiac monitoring, CK and renal testing, urinalysis, IV fluid and burn-centre consultation

Visible burn size substantially underestimates high-voltage injury. Dark urine and muscle tenderness raise concern for rhabdomyolysis and deep necrosis; ECG monitoring, electrolytes, CK, renal function and urine testing are required, with IV fluid titrated to renal and myoglobin risk. Burn-centre consultation is appropriate. Fasciotomy is indicated for a diagnosed compartment syndrome, not prophylactically in every tender limb.

Reference: https://emergencycarebc.ca/clinical_resource/clinical-summary/electrical-injuries/; https://www.cmaj.ca/content/190/38/E1137