A 29-year-old woman is brought to the urgent care clinic by a coworker after sustaining an electrical injury while working on power lines for the local utility. She was wearing safety gear but accidentally made contact with a high-voltage wire while performing a repair. The coworker reports that the patient very briefly lost consciousness when the incident occurred but then “seemed fine, just shook up.” The patient is most concerned about a burn on her hand, which was gloved when the incident occurred. Her vital signs show mild tachycardia and mild hypotension. What is the best next step in the management of this patient?
- Contact EMS to transfer the patient to the nearest ED.
- Perform an ECG.
- Order a complete metabolic panel, creatine phosphokinase, complete blood count, and urinalysis.
- Assess the burn on her hand
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Answer: A. Both high-voltage injury and loss of consciousness are criteria for emergent transfer to an ED via EMS. The patient should have an ECG and be placed on cardiac monitoring while awaiting transport, and it is reasonable to obtain laboratory values and begin evaluation of the burn while awaiting EMS, but initiation of ED transfer should not be delayed for any of these actions.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
