Airway stabilization is the first priority. Treatment of shock and other manifestations of massive burns is discussed in Ch. 276. Once vital functions have been reestablished, the full nature and extent of the injury must be evaluated and treated. Dislocations, fractures, and cervical-spinal and blunt injuries should be sought. Mannitol or furosemide may be indicated to increase renal flow.
Tetanus prophylaxis is required for any burn.
Baseline assessment for all electric injuries includes an ECG, cardiac enzymes, a CBC, and urinalysis, especially for myoglobin. Cardiac monitoring for 12 h is indicated if there is any suggestion of cardiac damage, arrhythmias, or chest pain. Any deterioration in the level of consciousness mandates a CT or MRI scan to rule out intracranial hemorrhage. Victims of lightning injuries may require cardiac resuscitation, monitoring, and supportive care. Fluid restriction is the rule because of potential brain edema.