Clinical Challenges in Burn Surgery: Electrical Burns - Part 1 of 2

High-voltage electrical injuries present unique clinical challenges characterized by significant internal tissue damage that often exceeds visible surface burns. These injuries follow a bimodal distribution, with low-voltage incidents common in pediatric populations and high-voltage trauma typically occurring in workplace settings. Because electricity follows the path of least resistance, structures like bone and muscle sustain severe thermal necrosis, often leading to rhabdomyolysis and acute kidney injury. Clinical management requires a rigorous trauma-based approach, including cervical spine immobilization and prolonged cardiac monitoring for up to 24 hours to detect delayed dysrhythmias. Resuscitation protocols for high-voltage cases necessitate higher fluid volumes—specifically 4 mL/kg/TBSA—with a target urine output of 100 mL/hour to clear myoglobin and hemoglobin, thereby mitigating the risk of renal failure. Effective intervention hinges on recognizing that external contact points often mask extensive internal musculoskeletal and systemic damage.