What is the immediate treatment for electrical injury?

Immediate Treatment of Electrical Injury

The immediate treatment for electrical injury should prioritize respiratory and cardiac arrest management using a traditional A-B-C approach (rather than C-A-B) due to the hypoxic nature of lightning injuries, with victims requiring immediate resuscitation. 1

Initial Safety and Assessment

1. Ensure scene safety

   • Confirm the power source is disconnected before touching the patient 1
   • Remove any glyceryl trinitrate patches from the chest wall to prevent explosions 1

2. Initial assessment

   • Assess the extent of injury using patient physiology, anatomical injury pattern, mechanism of injury, and response to initial resuscitation 2
   • Prioritize patients in respiratory or cardiac arrest when multiple victims are struck simultaneously 1

Immediate Resuscitation Algorithm

Airway Management

• Consider early intubation for patients with facial, mouth, or anterior neck burns, even if breathing spontaneously 1
• Protect cervical spine during all airway maneuvers 1
• Confirm tube placement by visualizing the glottis, listening to bilateral breath sounds, and watching for symmetrical chest expansion 1

Breathing

• Provide immediate ventilation support if respiratory arrest is present 1
• Apply initial normoventilation unless signs of imminent cerebral herniation are present 2

Circulation

• Begin high-quality CPR immediately if patient is pulseless 1
• Consider early defibrillation for ventricular fibrillation 1
• Be aware that intrinsic cardiac automaticity may spontaneously restore organized cardiac activity while respiratory arrest continues 1
• For extremity injuries with life-threatening bleeding, apply a tourniquet as an adjunct 2

Burn Management

• Apply cold tap water (15° to 25°C) to the burn site as soon as possible after ensuring electrical source disconnection 1
• Continue cooling until pain is relieved, monitoring for signs of hypothermia 1
• Leave burn blisters intact and cover them loosely with sterile dressing 1
• Initiate rapid IV fluid administration for victims with significant tissue destruction 1
• Maintain adequate diuresis to facilitate excretion of myoglobin, potassium, and other byproducts of tissue destruction 1

Monitoring and Further Management

• Perform neurological assessment for central and peripheral nervous system injuries 1
• Measure serum lactate or base deficit to estimate and monitor the extent of shock 2
• Consider early imaging (ultrasonography or CT) to detect internal injuries in patients with suspected torso trauma 2
• Perform early, repeated measurements of coagulation parameters (PT, APTT, fibrinogen, platelets) 2

Special Considerations

• Unlike conventional triage protocols, prioritize patients in respiratory or cardiac arrest when multiple victims are struck simultaneously 1
• Continue resuscitation unless there is evidence of injuries obviously incompatible with life 1
• Consider termination of resuscitation after at least 30 minutes of unsuccessful resuscitative efforts in traumatic cardiopulmonary arrest 1

Common Pitfalls to Avoid

• Do not rely on single hematocrit measurements as an isolated marker for bleeding 2
• Do not delay resuscitation efforts for electrical injury victims, as those who respond to immediate treatment have an excellent chance of recovery 1
• Do not overlook potential secondary injuries from falls, explosions, or trauma associated with the electrical injury 3
• Do not underestimate the potential for delayed complications, as electrical injuries can affect multiple organ systems 4