Volume Resuscitation in Patients With High-Voltage Electrical Injuries.

Abstract:

:Volume resuscitation of patients with high-voltage electrical injuries (>1000 V) is a more complex challenge than standard burn resuscitation. High voltages penetrate deep tissues. These deep injuries are not accounted for in resuscitation formulae dependent on percentage of cutaneous burn. Myonecrosis occurring from direct electrical injury and secondary compartment syndromes can result in rhabdomyolysis, compromising renal function and urine output. Urine output is the primary end point, with a goal of 1 mL/kg/h for adult patients with high-voltage electrical injuries. As such, secondary resuscitation end points of laboratory values, such as lactate, base deficit, hemoglobin, and creatinine, as well as hemodynamic monitoring, such as mean arterial pressure and thermodilution techniques, can become crucial in guiding optimum administration of resuscitation fluids. Mannitol and bicarbonates are available but have limited support in the literature. High-voltage electrical injury patients often develop acute kidney injury requiring dialysis and have increased risks of chronic kidney disease and mortality. Continuous venovenous hemofiltration is a well-supported adjunct to clear the myoglobin load that hemodialysis cannot from circulation.

journal_name

Ann Plast Surg

authors

Culnan DM,Farner K,Bitz GH,Capek KD,Tu Y,Jimenez C,Lineaweaver WC

doi

10.1097/SAP.0000000000001374

subject

Has Abstract

pub_date

2018-03-01 00:00:00

pages

S113-S118

issue

3 Suppl 2

eissn

0148-7043

issn

1536-3708

journal_volume

80

pub_type

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