What is the management approach for electrocution injury?

Management of Electrocution Injury

The management of electrocution injury requires immediate safety assessment, cardiopulmonary support, and specialized care with early transfer to a burn center for severe cases, particularly those involving high-voltage injuries, cardiac arrest, or significant tissue damage. 1

Initial Safety and Assessment

• First priority: Ensure scene safety

  • Turn off power at its source before approaching the victim 1
  • For high-voltage lines (e.g., fallen power lines), immediately notify authorities 1
  • Never touch the victim while power is still on (Class III, LOE C) 1
  • Do not attempt to remove wires with any object, even wooden ones 1

• Immediate assessment:

  • Assess for cardiac arrest (most common immediate cause of death) 1
  • Check for respiratory arrest (may result from respiratory center injury or muscle paralysis) 1
  • Evaluate for thermal burns at entry/exit points and along current pathway 1
  • Assess for signs of airway compromise (stridor, voice changes, difficulty breathing) 2
  • Look for soot around mouth/nose and singed nasal hairs 2

Resuscitation and Critical Care

• For cardiac arrest:

  • Begin CPR immediately using standard ACLS protocols 1
  • Use traditional A-B-C approach due to hypoxic nature of arrest 1
  • Early defibrillation for ventricular fibrillation 1
  • When multiple lightning strike victims are present, prioritize those in respiratory or cardiac arrest 1

• Airway management:

  • Position patient upright if no trauma is suspected 2
  • Consider early intubation for:
    • Signs of airway obstruction
    • Deep/circular burns on neck
    • Very extensive burns (TBSA >40%)
    • Facial/oral burns with risk of progressive swelling 2

• Fluid resuscitation:

  • Initiate IV fluid administration for victims with significant tissue destruction 1
  • Monitor fluid balance carefully with accurate intake/output records 2

Burn Management

• Thermal burn treatment:

  • Cool burns with cold (15° to 25°C) tap water until pain is relieved 1
  • Do not apply ice directly to burns (Class III, LOE B) 1
  • Leave burn blisters intact as this improves healing and reduces pain 1, 2
  • Cover burns with sterile, non-adherent dressings 1, 2
  • Apply antibiotic ointment for superficial injuries if no allergies 1

• Wound care:

  • Clean wounds thoroughly
  • Consider silicone dressings for eroded areas 2
  • Monitor for signs of infection (increased pain, redness, swelling, purulent drainage) 2

Monitoring and Specialized Care

• Cardiac monitoring:

  • Continuous ECG monitoring for all electrical injury patients 1, 2
  • Obtain baseline ECG and cardiac enzymes 2
  • Monitor for delayed arrhythmias, particularly with high-voltage injuries 1

• Neurological assessment:

  • Evaluate for central and peripheral neurological injuries 1
  • Monitor for signs of spinal cord injury if fall or forceful muscle contraction occurred 1
  • Assess for compartment syndrome in extremities (pain, pallor, paresthesia, pulselessness, paralysis) 2

• Transfer criteria to burn center:

  • High-voltage electrical injuries
  • Lightning strikes
  • Any electrical injury with cardiac arrest or significant tissue damage
  • Adults with burned body surface area >20% or deep burns >5% 2
  • Patients over 75 years or with severe comorbidities 2

Long-term Management

• Pain management:

  • Multimodal approach including acetaminophen, NSAIDs, and opioids as needed 2
  • Consider ketamine for severe pain 2

• Rehabilitation:

  • Early physical therapy to prevent contractures 2
  • Regular stretching exercises to improve flexibility 2
  • Consider massage therapy to soften scar tissue 2

• Follow-up care:

  • Multidisciplinary follow-up for severe cases 3
  • Monitor for delayed neurological, vascular, and cognitive symptoms 3
  • Regular wound assessment for healing or complications 2

Common Pitfalls and Caveats

• Safety hazards: Approaching victims before power is turned off is extremely dangerous and potentially fatal 1
• Underestimation of injury: Electrical injuries may have minimal external signs despite severe internal damage 3
• Delayed complications: Neurological and vascular symptoms may develop days to weeks after the initial injury 3
• Fluid overload: Excessive fluid administration can lead to pulmonary edema; careful monitoring is essential 2
• Missed compartment syndrome: Regular neurovascular checks are crucial to detect early signs of compartment syndrome 2
• Inadequate follow-up: Even patients with modest initial symptoms may develop significant long-term sequelae 3