Pediatric emergency medicine trisk 1970 1970
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Treat arrhythmias
Treat seizures
Tetanus toxoid; consider penicillin/other antibiotics
Consider general, oral, or plastic surgical consultation
Cerebral edema may develop over hours to days after injury, especially after a
lightning strike. If the child’s neurologic status fails to improve or deteriorates,
intracranial pressure monitoring and treatment may be necessary. Serum and
urine electrolytes and osmolality should be followed closely to recognize
promptly the syndrome of inappropriate antidiuretic hormone secretion.
Myoglobin in the urine is consistent with muscle breakdown and predisposes to
renal failure. Hydration and brisk diuresis with furosemide and/or mannitol may
prevent renal damage but must be undertaken with caution if there is coexistent
CNS injury. Extensive muscle damage after lightning injury is uncommon,
however, major CNS injury is common. Treatment should proceed with these
relative risks in mind until definitive information is available.
Most burns associated with low-voltage electrical injury are superficial.
Although they may become more apparent after several hours, most remain firstor second-degree burns. Minor burns on the extremities can be treated with
antibiotic ointment and should be allowed to slough and heal. Oral and plastic
surgeons should evaluate children who sustain oral burns. In most cases, similar
conservative management is recommended, but a removable stent may be
necessary to minimize scarring.
High-voltage injuries commonly require aggressive treatment. Fasciotomy may
be necessary to restore adequate circulation to an injured extremity when
compartment syndrome has developed. The approach to debridement of wounds
is controversial, but repeated examinations are considered most useful for
detecting nonviable tissue. Approximately 30% of survivors of high-tension
injuries ultimately require amputation of some part of an extremity.
The risk of infection in patients with deep tissue injury is high. Any patient not
clearly immunized against tetanus should be given tetanus toxoid. Some have
recommended prophylactic antibiotics for oral injuries, but in general,
antimicrobial therapy should be reserved for proven or strongly suspected
infection.
Indications for Discharge and Admission
Any patient who has sustained cardiopulmonary arrest, loss of consciousness, or
deep tissue injury should be admitted to the hospital for evaluation and treatment.
