High voltage cable burn to the hand!
In this case the patient came in contact with high voltage cable, the point of entry being the hand and the shoulder as the exit point, causing subdermal burns. 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 patients 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 initial evaluation.