Severe electrical injury of the hand!
This patient touched a high power line with his left hand, resulting in finger death and tissue destruction to part of the palm. Travelling up the arm, it damaged most of the forearm muscles along the way. Furthermore, this event also injured the heart and resulted in arrhythmias (irregular heartbeats).
Patients with electrical burns should be examined and treated following trauma patient treatment protocols with priority to ABCDEs with a primary and secondary survey.
A thorough history should be obtained, including the source of the patient's electrical injury, the voltage and current type (AC or DC) of the energy source, the duration of electrical exposure, and how the injury was incurred. It is also important to obtain the patient's cardiac history, including any history of prior arrhythmias. A head-to-toe examination should also be completed, giving particular attention to the skin, including the scalp.
EKG, cardiac enzymes, CBC, and urinalysis (to check for myoglobin due to rhabdomyolysis) should be obtained. Any patient that was in contact with a high-voltage source should have continuous cardiac monitoring during the initial evaluation.