What is the management of electrocution injuries?

Management of Electrocution Injuries

The management of electrocution injuries requires immediate medical attention with priority given to ensuring scene safety, providing cardiopulmonary support, and addressing both visible and internal injuries along the current pathway. 1

Initial Assessment and Safety

• First ensure the power source is disconnected before touching the victim to prevent rescuer injury 1, 2
• Assess for:
  • Respiratory and cardiac function
  • Level of consciousness
  • Entry and exit wound burns
  • Associated trauma (falls, fractures)

Immediate Management Algorithm

1. Cardiopulmonary Support

• Begin high-quality CPR immediately if patient is pulseless 1
• Consider early defibrillation for ventricular fibrillation 1
• Provide immediate ventilation support if respiratory arrest is present 1
• Apply initial normoventilation unless signs of imminent cerebral herniation are present 1

2. Fluid Resuscitation and Monitoring

• 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
• Monitor for cardiac arrhythmias (ventricular fibrillation, asystole, ventricular tachycardia) 1
• Measure serum lactate or base deficit to estimate and monitor the extent of shock 1

3. Wound and Burn Management

• Cool thermal burns with cold tap water (15-25°C) until pain is relieved 1
• Leave burn blisters intact and cover with sterile dressing 1, 2
• Do not apply ice directly to burns as it can produce tissue ischemia 2
• For extremity injuries with life-threatening bleeding, consider tourniquet application 1

Specific Injury Management

Neurological Injuries

• Monitor for altered mental status, seizures, and sensory disturbances 1
• Watch for tardive seizures that may occur after initial recovery 1
• Consider early imaging (CT) to detect internal injuries, particularly with head trauma 1, 3
• Consider electrophysiological monitoring if surgical intervention is planned 1

Musculoskeletal Injuries

• Immobilize suspected fractures, particularly in the spine 1, 3
• Apply a Philadelphia collar for cervical spine injuries 3
• Begin early rehabilitation with physical therapy focusing on range of motion exercises 1

Multiple Victims Management

• Prioritize patients in respiratory or cardiac arrest when multiple victims are affected 1
• Consider termination of resuscitation after at least 30 minutes of unsuccessful resuscitative efforts in traumatic cardiopulmonary arrest 1

Pitfalls and Caveats

1. Hidden Injuries: The extent of electrical injury may not be immediately apparent, with potential internal damage along the current pathway 1, 3

2. Delayed Complications: Monitor for delayed neurological sequelae, including seizures and sensory disturbances 1, 4

3. Cardiac Monitoring: Even seemingly minor electrical injuries require cardiac monitoring as arrhythmias may develop hours after the incident 1

4. Fluid Management: Aggressive fluid resuscitation is needed but must be balanced with monitoring for compartment syndrome in extremities 1

5. High-Voltage Injuries: These may cause extensive internal damage with minimal external signs and require more aggressive monitoring and management 3, 5

The management of electrical injuries requires a comprehensive approach due to the multisystem nature of these injuries. Early hospitalization and aggressive treatment significantly improve outcomes, as demonstrated in case reports of complete recovery following proper management 3.