Treatment of Electrical Injury at Primary Health Centre
All victims of electrical shock require immediate medical assessment and transfer to a hospital facility, as the extent of injury may not be apparent on initial presentation 1.
Immediate Scene Safety (CRITICAL FIRST STEP)
Before approaching the patient:
- Do NOT touch the victim while power is on - you will become a victim yourself 1
- Turn off power at the source (circuit breaker/fuse box for household injuries)
- For high-voltage injuries (fallen power lines): immediately notify emergency services and stay clear - all materials conduct electricity at high voltage, including wood 1
- Only approach once power is confirmed off by qualified personnel
Primary Assessment and Resuscitation
Once scene is safe, immediately assess and treat life-threatening conditions:
Cardiopulmonary Arrest
- Cardiopulmonary arrest is the primary cause of immediate death from electrocution 1
- Electrical current can cause ventricular fibrillation, asystole, or ventricular tachycardia 1
- Respiratory arrest may occur from brain injury or tetanic muscle contractions 1
- Initiate CPR immediately if no pulse
- Use defibrillator/AED as soon as available - follow standard ACLS protocols 2
- No modifications to standard CPR/ACLS are required for electrical injuries 3
Airway Management
- Consider early intubation even if patient is breathing spontaneously if there is evidence of:
- Facial burns
- Mouth/oral cavity burns
- Anterior neck burns
- Extensive soft-tissue swelling develops rapidly and will complicate delayed airway management 3
Cervical Spine Precautions
- Maintain spinal motion restriction by manually stabilizing the head 1
- Electrical injuries can cause falls or tetanic muscle contractions leading to spinal injury 4
- Do not use immobilization devices unless properly trained 1
Secondary Survey and Treatment
Burn Assessment and Management
- Examine for entry and exit wounds - thermal burns occur at contact points and along internal current pathway 1
- Cool thermal burns with cold tap water (15-25°C) until pain relieved 1
- Do NOT apply ice directly - causes tissue ischemia 1, 5
- Cover burns loosely with sterile dressing
- Leave blisters intact 1
Fluid Resuscitation
- Aggressive IV fluid administration is required for significant tissue destruction 3
- Standard burn formulas based on body surface area are INADEQUATE - hidden muscle damage requires more fluid 4, 6
- Maintain adequate urine output to facilitate excretion of myoglobin and potassium 3
Cardiac Monitoring
Assess for Associated Trauma
- Approximately 15% of electrical burn victims sustain traumatic injuries from falls or being thrown 4
- Tetanic muscle contractions can cause bone fractures 4
- Examine for fractures, dislocations, and internal injuries
Mandatory Transfer Criteria
ALL electrical injury patients require hospital evaluation 1. The primary health centre role is stabilization and rapid transfer.
Transfer is URGENT for:
- Any cardiac arrest or arrhythmia
- High-voltage exposure (>1000V) 7
- Loss of consciousness 7
- Respiratory distress 9
- Significant burns
- Evidence of muscle damage (myoglobin in urine, elevated creatine kinase) 9
- Any neurological symptoms
- Traumatic injuries
Critical Pitfalls to Avoid
Never assume injury is minor based on external appearance - internal damage along current pathway may be extensive while skin appears relatively uninjured 1, 8, 4
Do not use standard burn resuscitation formulas - they underestimate fluid needs in electrical injuries 4, 6
Do not delay transfer for "observation" - complications can be delayed but life-threatening 8, 7, 9
Do not forget to assess for myoglobin in urine - acute renal failure risk from muscle breakdown 3, 4
Do not overlook psychological trauma - long-term sequelae include psychological disorders in 25% of survivors 9