What is the most critical information to include in the care plan for a client with an electrical burn?

Critical Information for Care Planning in Electrical Burn Management

The most important information to include when planning care for a client with electrical burns with entrance wounds on hands and exit on feet is cardiac monitoring, as cardiopulmonary arrest is the primary cause of immediate death from electrocution. 1, 2

Initial Assessment and Monitoring

• Cardiac monitoring is essential as electrical injuries can cause various arrhythmias including ventricular fibrillation, ventricular asystole, and ventricular tachycardia, which may develop even after initial presentation 1, 2
• Assess for signs of shock and initiate fluid resuscitation with crystalloid isotonic fluids (0.9% saline solution) to counteract shock and facilitate excretion of myoglobin and potassium released from damaged tissue 1, 2
• Evaluate the extent of tissue damage, recognizing that visible skin damage often underestimates the true extent of internal injury in electrical burns 1
• Consider early intubation if there are extensive burns, particularly involving the face, mouth, or anterior neck 2

Fluid Management Considerations

• Administer fluids using a fluid challenge technique with boluses of 250-1000 ml and reevaluate after each bolus 1
• Monitor response to fluid resuscitation by measuring lactate levels (aim for 20% reduction in first hour) and clinical signs of tissue perfusion 1
• Consider vasopressors (such as norepinephrine) if hypotension persists despite adequate fluid resuscitation 1
• Monitor for signs of fluid overload such as pulmonary edema, especially in patients with limited access to mechanical ventilation 1

Wound Assessment and Management

• Thoroughly assess the entrance and exit wounds, recognizing that the pathway of current between these points has likely caused internal damage to tissues, blood vessels, nerves, and muscles 3
• Document the total body surface area (TBSA) affected using the Lund-Browder method, which is more accurate than other assessment methods 4
• Be aware that high-voltage electrical burns (>1000V) are associated with higher rates of amputation (23.6%) compared to low-voltage injuries (5.5%) 3
• Monitor for compartment syndrome, especially in the extremities along the current pathway from hands to feet, which may require surgical decompression 5

Systemic Complications to Monitor

• Assess renal function regularly, as acute renal failure is a major complication (occurring in approximately 18% of electrical burn patients) with high mortality rates 5
• Monitor for neurological deficits, which may occur immediately or be delayed, with approximately 16.7% of electrical burn patients developing such complications 3
• Evaluate for musculoskeletal complications, which occur in about 37% of electrical burn patients and may require major amputations 5
• Be vigilant for respiratory complications, as respiratory arrest may result from electric injury to the respiratory center in the brain or from tetanic contractions or paralysis of respiratory muscles 2

Common Pitfalls to Avoid

• Do not underestimate the severity of electrical injuries based on visible skin damage alone, as internal damage is often much more extensive 1
• Avoid inadequate fluid resuscitation, which can lead to acute renal failure from myoglobinuria 1, 5
• Do not delay surgical decompression when compartment syndrome is suspected, as this can lead to increased tissue damage and higher amputation rates 5
• Never fail to continuously monitor cardiac function, as missed arrhythmias are a significant cause of mortality in electrical burn patients 2