What injections are given for electrocution?

Management of Electrocution

The primary injection treatment for electrocution is intravenous epinephrine (1 mg/10 mL or 0.1 mg/mL) as part of advanced cardiac life support protocol, as ventricular fibrillation is the most common cardiac arrest rhythm in electrocution cases. 1, 2

Immediate Management

• Establish IV or IO access without interrupting chest compressions to deliver medications, as drug administration is secondary to high-quality CPR and rapid defibrillation 3
• Administer epinephrine through peripheral IV followed by a 20-mL bolus of IV fluid to facilitate drug flow from the extremity into central circulation 3
• If IV access is difficult to establish, intraosseous (IO) access is a reasonable alternative for medication delivery 3
• Synchronized cardioversion or unsynchronized high-energy shocks (defibrillation) may be necessary if the patient presents with a shockable rhythm 3

Pathophysiology and Mechanism

• Electrocution typically causes death through ventricular fibrillation, especially with alternating current which is three times more dangerous than direct current at low voltages 2, 4
• The human heart is extremely sensitive to alternating currents, with VF inducible at currents one-eighth of what's required for cardiac pacing 2
• Nerves have the lowest electrical resistance in the body, making neurological sequelae common in survivors 4, 5

Medication Administration Routes

• Peripheral IV is preferred over endotracheal administration, as studies show higher rates of ROSC and survival to hospital admission with IV drug delivery 3
• Central line placement (internal jugular or subclavian) may be considered during cardiac arrest if there are no contraindications, as it provides higher peak drug concentrations and shorter circulation times 3
• IO access provides delivery to a noncollapsible venous plexus, enabling drug delivery similar to peripheral venous access at comparable doses 3

Post-Resuscitation Care

• After successful initial resuscitation, patients should be treated in an intensive care environment 3
• Monitor airway patency and adequacy of ventilation during the reperfusion phase to minimize further tissue injury 3
• Regular blood gas analysis should be performed, and pulse oximetry may be used to assess oxygen saturation non-invasively 3
• Monitor and maintain electrolyte concentrations at low normal levels in comatose patients 3
• Control seizures with anticonvulsants such as diazepam, phenytoin, or barbiturates if they occur 3, 4

Neurological Considerations

• Neurological sequelae are common following electrocution due to the low resistance of nerve tissue 4
• Treatment with steroids may be beneficial for neurological injuries, particularly cerebral edema, as case reports have shown improvement in outcomes such as vision recovery 4
• Both immediate and delayed neurological manifestations can occur, requiring ongoing monitoring and appropriate intervention 4

Special Considerations

• Household accidents account for approximately 78% of electrocution cases, with a significant increase during summer months (June-September) 6
• Males are more commonly affected than females (74% vs 26%) 6
• The average age of electrocution victims is approximately 35 years 6
• Lightning strikes can cause substantial acute and chronic neural effects leading to cardiac arrest rhythms other than VF 2

Common Pitfalls to Avoid

• Do not delay cardioversion if the patient is extremely unstable 3
• Avoid interrupting chest compressions when establishing IV/IO access 3
• Remember that if electrocution current is strong enough, it will typically cause VF within 1-2 seconds; longer shocks do not tend to be more dangerous 2
• Be aware that post-mortem findings may not always show obvious electrical injuries, even when electrocution has clearly occurred 5