What is the immediate management for electrocution injury?

Immediate Management of Electrocution Injury

Ensure scene safety by turning off the power source before approaching the victim; once safe, immediately assess for cardiac arrest and begin CPR with the C-A-B sequence if the patient is unresponsive and not breathing, attaching an AED as soon as possible. 1, 2

Scene Safety and Initial Approach

• Do not approach the victim while power is still on – this is the most critical first step to prevent additional casualties 1
• Turn off the power at its source (typically near the fuse box in home settings) 1
• If power cannot be immediately turned off, use a non-conducting object to separate the victim from the electrical source 1, 2

Immediate Assessment and Resuscitation

Cardiopulmonary Assessment

• Assess responsiveness by talking to the victim and gently shaking their shoulders 1
• Cardiopulmonary arrest is the primary cause of immediate death from electrocution, making rapid assessment essential 1, 3
• If unresponsive and not breathing, begin standard CPR using the C-A-B sequence immediately 1, 2
• Attach an AED as soon as possible, as ventricular fibrillation is a common consequence of electrical injury 2

Respiratory Support

• For victims with respiratory arrest but maintained cardiac function, provide rescue breathing immediately 1, 2
• Lightning strike victims may experience spontaneous return of cardiac activity but continued respiratory arrest, requiring ventilatory support to prevent secondary hypoxic cardiac arrest 1, 2

Special Triage Consideration

• When multiple victims are struck simultaneously (as in lightning strikes), prioritize patients in respiratory or cardiac arrest – this reverses normal triage priorities 1, 2

Cardiac Management

Arrhythmia Monitoring and Treatment

• Continuous cardiac monitoring is essential due to high risk of arrhythmias including ventricular fibrillation, ventricular asystole, and ventricular tachycardia 2, 3
• Follow standard ACLS protocols without modification (except attention to possible cervical spine injury) 1
• Use synchronized cardioversion starting at 100 J for unstable monomorphic ventricular tachycardia with pulses 1, 2
• Use unsynchronized high-energy shocks for pulseless ventricular tachycardia or ventricular fibrillation 1, 2

Airway Management

• Consider early intubation for patients with extensive burns, particularly those involving the face, mouth, or anterior neck 1, 2, 3
• Use caution with airway control measures due to potential soft-tissue swelling 1, 2
• If vomiting occurs during resuscitation, turn the victim to the side and remove vomitus 1, 2
• If spinal cord injury is suspected, logroll the victim rather than simple turning 1, 2

Fluid Resuscitation

Initial Fluid Therapy

• Initiate therapy with crystalloid isotonic fluids (0.9% saline solution) as first-line treatment for patients showing signs of shock 2, 3
• Rapid IV fluid administration is particularly important for victims with significant tissue destruction to counteract shock and facilitate excretion of myoglobin, potassium, and other byproducts of tissue destruction 1, 2, 3
• Administer fluids using a fluid challenge technique with boluses of 250-1000 ml and reevaluate after each bolus 2, 3

Monitoring Resuscitation Response

• Evaluate response by measuring lactate levels (aiming for 20% reduction in the first hour) and clinical signs of tissue perfusion 3
• Consider vasopressors (such as norepinephrine) if hypotension persists despite adequate fluid resuscitation 3
• Monitor for signs of fluid overload such as pulmonary edema, especially in patients with limited access to mechanical ventilation 2, 3

Burn Assessment

• Document the total body surface area (TBSA) affected using the Lund-Browder method, which is more accurate than other assessment methods 2, 3

Critical Pitfalls to Avoid

• Underestimating injury severity based on visible skin damage can lead to delayed recognition of serious complications, as internal tissue damage often exceeds external appearance 2, 3
• Failure to monitor cardiac function can result in missed arrhythmias, which are a significant cause of mortality 2, 3
• Approaching the victim before ensuring the power source is off puts rescuers at risk 1, 2
• Neglecting spinal precautions when the mechanism suggests potential cervical spine injury 1