What is the treatment for an electrical injury?

Treatment of Electrical Injury

The treatment of electrical injury must begin with ensuring the power source is disconnected before touching the patient to prevent further injury, followed by immediate application of cold tap water (15° to 25°C) to the burn site to reduce edema, pain, and depth of injury. 1

Initial Management

1. Safety First

   • Ensure the electrical source is disconnected before approaching the victim
   • Remove any glyceryl trinitrate patches or ointments from the chest wall to prevent explosions 2

2. Immediate Resuscitation

   • For cardiac arrest: Begin standard CPR with C-A-B sequence
   • For victims of lightning strike: Consider traditional A-B-C approach due to the hypoxic nature of the arrest 2
   • Perform precordial thump if asystole is present 2

3. Burn Management

   • Apply cold tap water (15-25°C) to the burn site until pain is relieved 1
   • Leave burn blisters intact and cover loosely with sterile dressing 1
   • Monitor for signs of hypothermia, especially in patients with extensive burns 1

Advanced Management

Cardiac Monitoring and Treatment

• Continuous cardiac monitoring for at least 24 hours, especially for high-voltage injuries 3
• Standard ACLS protocols for cardiac arrhythmias 2
• Consider early defibrillation for ventricular fibrillation 2

Airway Management

• Early intubation for patients with facial, mouth, or neck burns due to risk of rapid soft-tissue swelling 1
• Tracheal intubation is preferred for airway control during resuscitation 2
• Confirm correct tube placement by visualizing the glottis, listening to bilateral breath sounds, and watching for symmetrical chest expansion 2

Fluid Resuscitation

• Rapid IV fluid administration for patients with significant tissue destruction 1
• Maintain adequate diuresis to facilitate excretion of myoglobin and other byproducts of tissue destruction 1
• Monitor for rhabdomyolysis and associated renal complications 4

Special Considerations

For High-Voltage Injuries

• More aggressive monitoring and intervention due to higher risk of internal damage 3
• Consider surgical consultation for fasciotomy if compartment syndrome is suspected 5
• In severe cases with refractory shock, consider veno-arterial extracorporeal life support (VA ECLS) 6

For Lightning Injuries

• Prioritize patients in respiratory or cardiac arrest when multiple victims are struck simultaneously 2
• Be aware that intrinsic cardiac automaticity may spontaneously restore organized cardiac activity, but respiratory arrest may continue 2

Monitoring and Follow-up

• Comprehensive assessment of the current pathway through the body to identify potential internal injuries 3
• Monitor for delayed complications:
  • Cardiac arrhythmias
  • Neurological deficits
  • Vascular damage
  • Compartment syndrome
  • Renal failure from myoglobinuria 4

Pitfalls and Caveats

• Don't underestimate low-voltage injuries: Even household current can cause fatal electrocutions 2
• Beware of the "iceberg effect": External burns may appear minor while concealing extensive internal damage 5
• Watch for delayed arrhythmias: Cardiac monitoring is essential even in apparently stable patients 3
• Don't neglect secondary trauma: Falls, fractures, and dislocations commonly accompany electrical injuries 4
• Consider cervical spine injury: Pay attention to possible cervical spine injury when establishing an airway 2

The management of electrical injuries requires a systematic approach focusing on both immediate life-threatening conditions and potential delayed complications. Early intervention with proper cooling of burn sites and adequate fluid resuscitation significantly improves outcomes 1.