Page 80 - ATP-P 11th Ed

Electrical Burns
a. TCCC ASM and CLS personnel should remove the patient from the electricity source
SECTION 1 b. For cardiac arrest due to arrhythmia after electrical injury, follow advanced cardiac life
while avoiding injury themselves.
support (ACLS) protocol and provide hemodynamic monitoring if spontaneous circula-
tion returns.
c. Small skin contact points (cutaneous burns) can hide extensive soft tissue damage.
d. Observe the patient closely for clinical signs of compartment syndrome.
e. Tissue that is obviously necrotic must be surgically debrided.
NOTE: Escharotomy, which relieves the tourniquet effect of circumferential burns, will
not necessarily relieve elevated muscle compartment pressure due to myonecrosis associ-
ated with electrical injury; therefore, fasciotomy is usually required.
a. Compartment syndrome and muscle injury may lead to rhabdomyolysis, causing pig-
menturia and renal injury.
b. Pigmenturia typically presents as red-brown urine. In patients with pigmenturia, fluid
resuscitation requirements are much higher than those predicted for a similar-sized ther-
mal burn.
c. Isotonic fluid infusion should be adjusted to maintain UOP 75–100mL/hr in adult pa-
tients with pigmenturia.
d. If the pigmenturia does not clear after several hours of resuscitation consider IV in-
fusion of mannitol, 12.5g/L of lactated Ringer’s solution, and/or sodium bicarbonate
(150mEq/L in D5W). These infusions may be given empirically; it is not necessary to
monitor urinary pH. In patients receiving mannitol (an osmotic diuretic), close monitor-
ing of intravascular status via CVP and other parameters is required.
e. Seek early consultation from the USAISR Burn Center (DSN 312-429-2876
(BURN); Commercial (210) 916-2876 or (210) 222-2876; email burntrauma.consult
.army@mail.mil).
Pediatric Burn Injuries
a. Children with acute burns over 15% of the body surface usually require a calculated
resuscitation.
b. Place a bladder catheter if available (size 6 Fr for infants and 8 Fr for most small
children).
c. The Modified Brooke formula (3mL/kg/%TBSA LR or other isotonic fluid divided over
24 hours, with one-half given during the first 8 hours) is a reasonable starting point.
This only provides a starting point for resuscitation, which must be adjusted based on
UOP and other indicators of organ perfusion. Goal UOP for children is 0.5–1mL/kg/hr.
d. Very young children do not have adequate glycogen stores to sustain themselves during
resuscitation. Administer a maintenance rate of D5LR to children weighing <20kg. Uti-
lize the 4-2-1 rule: 4mL/kg for the first 10kg + 2mL/kg 2nd 10kg + 1mL/kg over 20kg.

70 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 71