Typical "high voltage" injury with deep burns at foot exit. Note: the need for fasciotomy above the burn because of compartment syndrome and current of injury damage to muscle. The exposed muscle is clearly dead tissue reflecting the hidden injury and need for early transfer. Decision for fasciotomy is dependent on symptoms of neurovascular compression or preferably assessment of compartment pressures.

Myoglobinuria as seen on far right indicates 1) severe muscle damage and 2) the need to flush out kidneys to avoid resuscitation renal damage. Note: Clearing of urine during increased fluid infusion, mannitol and alkalinizing the urine (pH > 6) to avoid pigment damage, are require. This patient needs to be transferred.

SUMMARY OF INITIAL TREATMENT OF HIGH-TENSION INJURY