What is the treatment for electric shock?

Treatment of Electric Shock

The immediate treatment for electric shock requires a traditional A-B-C approach (rather than C-A-B) due to the hypoxic nature of electrical injuries, with immediate CPR for pulseless patients and early defibrillation for ventricular fibrillation. 1

Initial Assessment and Management

Safety First

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

Immediate Resuscitation

1. For cardiac arrest (most common cause of death after electrical shock):

   • Begin high-quality CPR immediately if patient is pulseless 1
   • Apply early defibrillation for ventricular fibrillation 1
   • For VF or pulseless VT: Use unsynchronized electric shock with initial monophasic energy of 200J; if unsuccessful, second shock of 200-300J; if necessary, third shock of 360J 2
   • For refractory VF/VT: Administer amiodarone 300mg or 5mg/kg IV bolus followed by repeat unsynchronized shock 2

2. For respiratory arrest:

   • Provide immediate ventilation support 1
   • Consider early intubation for patients with facial, mouth, or anterior neck burns 1
   • Protect cervical spine during all airway maneuvers 1

Specific Cardiac Rhythm Management

Ventricular Fibrillation (VF)

• Use single shock protocol rather than 3-stacked-shock protocol 2
• After shock, immediately resume CPR beginning with chest compressions 2
• Minimize interruptions to chest compressions for rhythm analysis 2

Ventricular Tachycardia (VT)

• Sustained polymorphic VT: Treat with unsynchronized electric shock (200J initial monophasic energy) 2
• Sustained monomorphic VT with hemodynamic compromise: Use synchronized cardioversion starting at 100J 2
• Drug-refractory polymorphic VT: Aggressively reduce myocardial ischemia with beta-blockers, intra-aortic balloon pumping 2

Burn and Wound Management

• Apply cold tap water (15-25°C) to burn sites immediately after ensuring electrical source is disconnected 1
• Continue cooling until pain is relieved, monitoring for hypothermia 1
• Leave burn blisters intact and cover 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 and potassium 1

Electrolyte Management

• Correct electrolyte and acid-base disturbances to prevent recurrent VF 2
• Aggressively normalize serum potassium to >4.0 mEq/L and magnesium to >2.0 mg/dL 2
• Monitor for signs of rhabdomyolysis and hyperkalemia 1

Special Considerations

• Unlike conventional triage, prioritize patients in respiratory or cardiac arrest when multiple victims are struck simultaneously 1
• Continue resuscitation for prolonged periods as successful outcomes have been reported after extended CPR in electrical shock victims 3
• Consider early imaging (ultrasonography or CT) to detect internal injuries 1
• Evaluate any person with high voltage (≥500V) shock with echocardiography and cardiac catheterization if indicated 4

Pitfalls to Avoid

• Do not touch the patient before ensuring the power source is disconnected 1
• Do not rely on single hematocrit measurements as an isolated marker for bleeding 1
• Avoid prophylactic antiarrhythmic therapy as it is not recommended 2
• Do not treat isolated ventricular premature beats, couplets, or nonsustained VT unless they lead to hemodynamic compromise 2
• Do not terminate resuscitation efforts prematurely, as electrical shock victims may have better chances for successful resuscitation due to typically younger age and less underlying cardiac disease 5

Remember that electrical injuries can cause multisystem damage beyond the obvious burns, including cardiac arrhythmias, respiratory arrest, neurological complications, and internal tissue damage that may not be immediately apparent.