What is the treatment for electric shock to the hand?

Treatment for Electric Shock to the Hand

The immediate treatment for electric shock to the hand includes ensuring scene safety, assessing the victim, providing CPR if needed, and monitoring for cardiac arrhythmias for at least 24 hours in patients with significant exposure. 1

Initial Approach and Safety

• Turn off the power source before approaching the victim; if power cannot be immediately turned off, use a non-conducting object to separate the victim from the electrical source 1
• Assess the victim's responsiveness by talking to them and gently shaking their shoulders once they are separated from the electrical source 1

Immediate Medical Assessment

• Assess for cardiopulmonary arrest - if the victim is unresponsive and not breathing, begin standard CPR with the C-A-B sequence (Compressions, Airway, Breathing) 1
• Attach an AED as soon as possible to identify and treat ventricular fibrillation or pulseless ventricular tachycardia, which are common causes of death following electrical shock 2, 3
• For victims with respiratory arrest but maintained cardiac function, provide rescue breathing immediately 1

Cardiac Management

• Monitor for cardiac arrhythmias, which may occur even after apparent recovery 4
• For unstable monomorphic ventricular tachycardia with pulses, use synchronized cardioversion starting at 100 J 5
• For pulseless ventricular tachycardia or ventricular fibrillation, use unsynchronized high-energy shocks 5
• If using monophasic defibrillators, begin with 200 J; if unsuccessful, give a second shock of 200-300 J, and if necessary, a third shock of 360 J 5
• If using biphasic defibrillators, follow manufacturer recommendations for energy levels 5
• For refractory VF or pulseless VT, consider amiodarone (300 mg or 5 mg/kg IV bolus) followed by repeat unsynchronized electric shock 5

Fluid Resuscitation and Burn Management

• Administer rapid IV fluid for victims with significant tissue destruction to counteract shock and facilitate excretion of myoglobin, potassium, and other byproducts of tissue destruction 1
• Assess for thermal burns at entry and exit points, which may require specific burn management 6

Monitoring and Hospitalization

• Patients with significant electrical exposure should be monitored for at least 24 hours due to the risk of delayed cardiac arrhythmias 4
• Low-voltage injuries with no loss of consciousness and normal ECG may be considered for discharge from the emergency department, but this should be evaluated on a case-by-case basis 4

Special Considerations

• Consider potential for associated trauma from falls or being thrown by the electrical current 6
• Correct electrolyte and acid-base disturbances (potassium >4.0 mEq/L and magnesium >2.0 mg/dL) to prevent recurrent episodes of ventricular fibrillation 5
• Consider early intubation for patients with extensive burns, particularly those involving the face, mouth, or anterior neck 1

Pitfalls to Avoid

• Do not terminate resuscitation efforts prematurely in electrical shock victims, as successful resuscitation has been reported even after prolonged CPR (65 minutes in one case) 3
• Do not neglect the possibility of cervical spine injury in electrical shock victims who may have fallen or been thrown by the current 1
• Do not assume that the absence of external burns indicates a minor injury, as internal damage can be significant despite minimal external signs 4