What is the immediate management for a victim of electric shock?

Immediate Management of Electric Shock Victims

The immediate management of an electric shock victim requires first ensuring scene safety by turning off the power source before approaching the victim, followed by assessment and provision of CPR if needed, with special attention to potential cardiac arrhythmias and respiratory arrest. 1

Initial Approach: Safety First

• Before approaching any victim of electric shock, ensure the power source is turned off to prevent rescuer injury 1
• If power cannot be immediately turned off, use a non-conducting object (such as a wooden broom handle) to separate the victim from the electrical source 2
• Once the scene is safe, assess the victim's responsiveness by talking to them and gently shaking their shoulders 2

Immediate Medical Assessment and Interventions

• Assess for cardiopulmonary arrest, which is the primary cause of immediate death from electrocution 1, 2
• If the victim is unresponsive and not breathing, begin standard CPR with the C-A-B sequence (compressions, airway, breathing) 2
• Attach an AED as soon as possible and follow prompts for defibrillation if a shockable rhythm is identified 2
• For victims with respiratory arrest but maintained cardiac function, provide rescue breathing immediately 2
• When multiple victims are struck simultaneously by lightning, prioritize patients in respiratory or cardiac arrest 2

Specific Cardiac Management

• Monitor for cardiac arrhythmias including ventricular fibrillation, asystole, and ventricular tachycardia, which commonly result from electrical injuries 1, 3
• No modifications to standard ACLS protocols are required for electrical injury victims, except attention to possible cervical spine injury 2
• For unstable monomorphic ventricular tachycardia with pulses, use synchronized cardioversion starting at 100 J 2
• For pulseless ventricular tachycardia or ventricular fibrillation, use unsynchronized high-energy shocks (defibrillation) 2

Airway Management

• Consider early intubation for patients with extensive burns, particularly those involving the face, mouth, or anterior neck 2
• Extensive soft-tissue swelling may develop rapidly, complicating airway control measures 2
• If vomiting occurs during resuscitation, turn the victim to the side and remove vomitus using your finger, a cloth, or suction 2
• If spinal cord injury is suspected, logroll the victim so the head, neck, and torso move as a unit to protect the cervical spine 2

Fluid Resuscitation and Further Management

• For victims with significant tissue destruction who regain a pulse, administer rapid IV fluid resuscitation 2, 4
• Use isotonic crystalloid fluids (0.9% saline solution) as first-line therapy for patients showing signs of shock 4
• Administer fluids using a fluid challenge technique with boluses of 250-1000 ml and reevaluation after each bolus 4
• Monitor for signs of fluid overload, especially in patients with limited access to mechanical ventilation 4

Common Pitfalls and Considerations

• Underestimating injury severity based on visible skin damage can lead to delayed recognition of serious complications 4
• Failure to monitor cardiac function can result in missed arrhythmias, which are a significant cause of mortality 4
• Even patients who appear stable initially may develop delayed cardiac arrhythmias and require monitoring 3
• Electrical burns often cause more severe internal damage than is apparent from external examination 3

Special Considerations

• Alternating current (AC) is generally more dangerous than direct current (DC) due to its ability to cause tetanic muscle contractions that "lock" victims to the electrical source 1
• Lightning strike victims may experience spontaneous return of cardiac activity but continued respiratory arrest, requiring ventilatory support to prevent secondary hypoxic cardiac arrest 2
• Patients with electrical injuries are often young and without underlying cardiac disease, potentially increasing chances for successful resuscitation 5