Which intervention may be required in high-voltage electrical injuries due to potential deep tissue damage and rhabdomyolysis?

Which intervention may be required in high-voltage electrical injuries due to potential deep tissue damage and rhabdomyolysis?

• A. Aggressive fluid resuscitation with monitoring for rhabdomyolysis
• B. Immediate antibiotic therapy only
• C. No intervention beyond wound care
• D. Isolation for infection control only

Answer: (A)

High-voltage injuries can cause deep muscle damage that isn’t always visible on the skin. The damaged muscle can release large amounts of intracellular contents, notably myoglobin and potassium, leading to rhabdomyolysis and potential acute kidney injury as well as dangerous electrolyte disturbances. The most important and often required intervention is aggressive IV fluid resuscitation with close monitoring for rhabdomyolysis. Starting isotonic fluids early helps maintain renal perfusion and dilutes and flushes myoglobin through the kidneys, reducing the risk of tubular obstruction and renal failure. Target urine output is typically maintained at about 0.5–1 mL/kg/hour in adults, with serial checks of kidney function, creatine kinase levels, and electrolytes. Continuous cardiac monitoring is also important due to the risk of arrhythmias from potassium shifts. Wound care and infection control remain important, but they do not address the systemic risks posed by rhabdomyolysis.

High-voltage injuries can cause deep muscle damage that isn’t always visible on the skin. The damaged muscle can release large amounts of intracellular contents, notably myoglobin and potassium, leading to rhabdomyolysis and potential acute kidney injury as well as dangerous electrolyte disturbances. The most important and often required intervention is aggressive IV fluid resuscitation with close monitoring for rhabdomyolysis. Starting isotonic fluids early helps maintain renal perfusion and dilutes and flushes myoglobin through the kidneys, reducing the risk of tubular obstruction and renal failure. Target urine output is typically maintained at about 0.5–1 mL/kg/hour in adults, with serial checks of kidney function, creatine kinase levels, and electrolytes. Continuous cardiac monitoring is also important due to the risk of arrhythmias from potassium shifts. Wound care and infection control remain important, but they do not address the systemic risks posed by rhabdomyolysis.