What are the clinical symptoms and treatment protocols for electric shock with an entry wound on the fingers?

Clinical Symptoms and Management of Electric Shock with Entry Wound on Fingers

Electric shock injuries with entry wounds on the fingers require immediate medical attention as they can cause severe local and systemic damage, with potential for cardiac arrhythmias, respiratory arrest, and tissue destruction along the current pathway. 1

Clinical Symptoms of Electric Shock

Immediate Symptoms

• Cardiac effects: Arrhythmias including ventricular fibrillation, ventricular asystole, and ventricular tachycardia 1
• Respiratory effects: Respiratory arrest from injury to respiratory center or tetanic contractions/paralysis of respiratory muscles 1
• Neurological symptoms: Altered mental status ranging from anxiety to confusion, lethargy, or loss of consciousness 1
• Pain and sensory disturbances: Tingling sensations to severe pain at entry/exit points 1

Visible Physical Signs

• Entry and exit wounds: Thermal burns at entry point (fingers) and exit point 1
• Internal pathway burns: Tissue damage along the current's internal pathway 1
• Tissue damage: Visible thermal burns, potential tissue necrosis 1

Delayed Symptoms

• Cardiovascular: Ongoing arrhythmias, myocardial damage 2
• Renal complications: Due to myoglobin release from damaged muscles 2
• Neurological sequelae: Ongoing confusion, memory issues, or peripheral nerve damage 2

Significance of Entry Wound on Fingers

Entry wounds on the fingers are particularly concerning because:

1. Current pathway: Electricity may travel from the hand through vital organs (heart, lungs) before exiting, creating a dangerous transthoracic pathway 1, 2

2. Deep tissue damage: Visible surface burns may underestimate the extent of internal damage along the current pathway 1

3. Compartment syndrome risk: Swelling within confined finger/hand compartments can compromise circulation 2

4. Functional impact: Damage to tendons, nerves, and blood vessels can lead to permanent disability 2

Management Protocol

Immediate Actions

1. Ensure scene safety: Disconnect power source before touching the victim 3
2. Primary assessment: Check for cardiac and respiratory function 2
   • Begin CPR immediately if pulseless 2
   • Consider early defibrillation for ventricular fibrillation 2
   • Provide respiratory support if breathing is compromised 2

Medical Management

1. Cardiac monitoring: Continuous ECG monitoring for at least 24 hours for high-voltage injuries 2

2. Wound care:

   • Cool thermal burns with cold tap water (15-25°C) until pain is relieved 1, 2
   • Leave burn blisters intact and cover with sterile dressing 1, 2
   • Look for both entry and exit wounds 3

3. Fluid management:

   • Initiate IV fluid administration for significant tissue destruction 2
   • Maintain adequate diuresis to facilitate excretion of myoglobin and potassium 2

4. Pain control: Provide appropriate analgesia for burn pain 2

Special Considerations for Finger Entry Wounds

1. Vascular assessment: Check capillary refill, pulses, and sensation in affected digits 2

2. Compartment syndrome monitoring: Watch for signs of increasing pain, pallor, paresthesia, and pulselessness 2

3. Functional assessment: Evaluate range of motion and nerve function in affected digits 2

When to Seek Emergency Care

All electric shock victims should receive medical assessment because the extent of injury may not be immediately apparent 1. Immediate medical attention is essential when:

• Any cardiac symptoms are present (palpitations, chest pain)
• Loss of consciousness occurred
• Burns are visible
• Entry wound is on fingers with potential transthoracic pathway
• High-voltage exposure is suspected

Complications to Monitor

• Cardiac arrhythmias: May develop hours after the initial injury 4
• Compartment syndrome: Especially in extremities with entry/exit wounds 2
• Rhabdomyolysis: Leading to renal failure 5
• Neurological sequelae: Including seizures or peripheral nerve damage 2
• Vascular damage: Potentially leading to thrombosis or delayed bleeding 2

Prevention

• Ensure proper electrical safety measures in workplaces and homes 3
• Use appropriate protective equipment when working with electricity 3
• Immediately disconnect power before attempting rescue of shock victims 3

Electric shock with finger entry wounds represents a serious medical emergency requiring prompt assessment and treatment to prevent life-threatening complications and long-term disability.