Treat arrhythmias Treat seizures Tetanus toxoid; consider penicillin/other antibiotics Consider general, oral, or plastic surgical consultation Cerebral edema may develop over hours to days after injury, especially after a lightning strike If the child’s neurologic status fails to improve or deteriorates, intracranial pressure monitoring and treatment may be necessary Serum and urine electrolytes and osmolality should be followed closely to recognize promptly the syndrome of inappropriate antidiuretic hormone secretion Myoglobin in the urine is consistent with muscle breakdown and predisposes to renal failure Hydration and brisk diuresis with furosemide and/or mannitol may prevent renal damage but must be undertaken with caution if there is coexistent CNS injury Extensive muscle damage after lightning injury is uncommon, however, major CNS injury is common Treatment should proceed with these relative risks in mind until definitive information is available Most burns associated with low-voltage electrical injury are superficial Although they may become more apparent after several hours, most remain firstor second-degree burns Minor burns on the extremities can be treated with antibiotic ointment and should be allowed to slough and heal Oral and plastic surgeons should evaluate children who sustain oral burns In most cases, similar conservative management is recommended, but a removable stent may be necessary to minimize scarring High-voltage injuries commonly require aggressive treatment Fasciotomy may be necessary to restore adequate circulation to an injured extremity when compartment syndrome has developed The approach to debridement of wounds is controversial, but repeated examinations are considered most useful for detecting nonviable tissue Approximately 30% of survivors of high-tension injuries ultimately require amputation of some part of an extremity The risk of infection in patients with deep tissue injury is high Any patient not clearly immunized against tetanus should be given tetanus toxoid Some have recommended prophylactic antibiotics for oral injuries, but in general, antimicrobial therapy should be reserved for proven or strongly suspected infection Indications for Discharge and Admission Any patient who has sustained cardiopulmonary arrest, loss of consciousness, or deep tissue injury should be admitted to the hospital for evaluation and treatment