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Electrical injury — MCCQE Part 1 MCQ

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ModerateTraumaElectrical injuryMCCQE Part 1

A 32-year-old electrician sustains a high-voltage electrical injury. He has a small entry burn on one hand and an exit wound on one foot, feels well, and reports no loss of consciousness. What is the most appropriate disposition and evaluation?

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Correct answer: B — Admit for cardiac monitoring, burn consultation, and assessment for deep injury, compartment syndrome, and rhabdomyolysis

Option B is best. High-voltage current may damage muscle, vessels, nerves, and other deep tissues along its path even when entry and exit burns look small. Initial evaluation includes an ECG and monitoring, a complete trauma and burn examination, and laboratory assessment such as electrolytes, renal function, creatine kinase, and urinalysis for evidence of rhabdomyolysis. Serial limb examination is important because tissue oedema can produce compartment syndrome. Emergency Care BC recommends admission and burn-centre referral for all high-voltage injuries. The absence of loss of consciousness or a normal initial ECG does not convert this into a minor topical burn, and prophylactic systemic antibiotics are not a substitute for occult-injury assessment.

Reference: Emergency Care BC, Electrical Injuries: https://emergencycarebc.ca/clinical_resource/clinical-summary/electrical-injuries/