efforts to restore adequate cardiopulmonary and cerebral function, especially in the lightning victim, may be appropriate in the context of bizarre neurologic phenomena that inhibit ventilatory efforts, consciousness, or pupillary function The patient who fails to respond to resuscitative efforts over hours to days and meets standard brain death criteria should be pronounced dead Any patient who sustains electrical injury needs a comprehensive physical examination Bleeding or edema from orofacial burns may compromise the upper airway The head, particularly eyes, and neck should be examined carefully for evidence of trauma The skin should be examined carefully for burns and bruises Limbs should be evaluated for pulses, perfusion, and motor and sensory function, as well as for soft tissue swelling or evidence of fractures Burns and deep tissue injury may progress over hours to days, so repeated examination and monitoring are important Neurologic evaluation is especially important in all but the most minor, localized peripheral injuries Level of consciousness and mental status should be assessed and cranial nerve, cerebellar, motor, and sensory function should be evaluated Children who have sustained minor household electrical injuries and are asymptomatic usually not require laboratory evaluation, cardiac evaluation, or hospitalization In cases of a high-tension injury or lightning strike, evaluation should include ECG, CBC, CPK, troponin, BUN, creatinine, and urinalysis, including urine myoglobin Physical examination that reveals evidence of bruises, bony tenderness, or distorted long bones should prompt appropriate radiographic studies Most children who sustain burns of the oral commissure (usually after biting an electrical cord) not require extensive evaluation or admission In cases of severe orofacial burns, use of an artificial airway should be considered before progressive edema leads to catastrophe Mechanical ventilation may be necessary to overcome CNS depression or primary lung involvement Patients with coma and loss of protective airway reflexes should be intubated to avoid aspiration Good oxygenation and ventilation adequate to maintain a normal pH and PaCO must be ensured Seizure activity should be treated (see Chapter 72 Seizures ) The neck and back should be immobilized if the patient was thrown from the site of injury If the mechanism of injury was severe, a cervical collar should be maintained in place despite normal cervical spine radiographs until more definitive evaluation can be accomplished If a child fails to regain consciousness