What are the immediate management steps for a patient with electrocution?

Immediate Management of Electrocution

The first priority in managing electrocution is ensuring scene safety by turning off the power source before approaching the victim, followed by assessment and immediate CPR if the patient is in cardiac arrest. 1

Initial Safety and Assessment

1. Ensure scene safety

   • Turn off power at its source (fuse box for home electrocutions) 1
   • For high-voltage electrocutions (fallen power lines), notify authorities (911/fire department) 1
   • Do not touch the victim or use any objects (even wooden ones) to remove wires until power is confirmed off 1

2. Initial assessment

   • Once safe, assess responsiveness, breathing, and circulation 1
   • Check for pulse and normal breathing within 10 seconds 1
   • If unresponsive with no breathing or only gasping, assume cardiac arrest 1

Management Algorithm Based on Patient Status

For Cardiac Arrest

1. Begin high-quality CPR immediately

   • Compression rate: at least 100/min
   • Compression depth: at least 2 inches (5 cm)
   • Allow complete chest recoil after each compression
   • Minimize interruptions in chest compressions 1

2. Apply AED/defibrillator as soon as available

   • Follow AED prompts
   • Resume chest compressions immediately after shock 1
   • Standard ACLS protocols apply with no specific modifications for electrical injuries 1

3. Consider early intubation

   • Especially with facial/neck burns where rapid swelling may occur
   • Intubate early even if patient is breathing spontaneously if extensive burns are present 1

For Respiratory Arrest Only

1. Provide rescue breathing
   • One breath every 5-6 seconds
   • Recheck pulse every 2 minutes 1
   • Continue until spontaneous breathing returns 1

For Patients with Pulse and Breathing

1. Assess for injuries

   • Look for entry and exit burn points 1
   • Assess for thermal burns from burning clothing 1
   • Check for signs of trauma (patients may have fallen or been thrown) 1

2. Spinal precautions

   • Manually stabilize the head to minimize motion of head, neck, and spine 1
   • Particularly important if trauma is suspected

Critical Management Considerations

Fluid Resuscitation

• For victims with significant tissue destruction, rapid IV fluid administration is essential 1
• Counteracts distributive/hypovolemic shock
• Maintains diuresis to facilitate excretion of myoglobin and potassium 1

Thermal Burns Management

• Cool thermal burns with cold (15-25°C) tap water until pain is relieved 1
• Do not apply ice directly to burns (can cause tissue ischemia) 1
• Leave burn blisters intact and cover loosely with sterile dressing 1

Monitoring and Transport

• All victims of electric shock require medical assessment 1
• Monitor for cardiac arrhythmias (VF, VT, asystole) 1
• Extent of injury may not be immediately apparent 1

Special Considerations

Multiple Victims (Lightning Strike)

• Reverse normal triage priorities - attend to those in cardiac/respiratory arrest first 2
• Lightning victims who do not suffer immediate arrest have excellent chance of recovery 1

Common Pitfalls to Avoid

1. Underestimating injury severity

   • Internal damage may be extensive despite minimal external signs 1
   • Tissue destruction can be much deeper than apparent surface burns

2. Delayed airway management

   • Rapid soft tissue swelling can complicate airway control 1
   • Early intubation is recommended with extensive burns

3. Inadequate fluid resuscitation

   • Significant third spacing and ongoing fluid losses require aggressive replacement 1

4. Neglecting spinal precautions

   • Victims may have associated trauma from falls or muscle contractions 1

5. Premature termination of resuscitation

   • Victims of electrical injury often have better chances of successful resuscitation than other cardiac arrest causes due to typically younger age and lack of underlying cardiac disease 2

Electrocution injuries require prompt, aggressive management with attention to both the direct effects of electrical current and associated multisystem injuries. All patients should be transported to a healthcare facility for comprehensive evaluation regardless of their apparent condition at the scene.