What is the immediate management for a patient with electric shock?

Immediate Management of Electric Shock

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 unresponsive and not breathing, attach an AED as soon as possible, and provide 100% oxygen with early intubation for severe cases. 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 power at its source (typically near the fuse box in home settings); if immediate power shutoff is impossible, use a non-conducting object to separate the victim from the electrical source 1, 2
• Once the scene is secure, assess responsiveness by talking to the victim and gently shaking their shoulders 1

Immediate Resuscitation

Cardiopulmonary Assessment and Support

• Assess for cardiopulmonary arrest immediately - this is the primary cause of death from electrocution 1, 3
• Begin standard CPR using the C-A-B sequence (Compressions-Airway-Breathing) if the victim is unresponsive and not breathing 1, 2
• Attach an AED as soon as possible - ventricular fibrillation is a common consequence requiring immediate defibrillation 1, 2
• For victims with respiratory arrest but maintained cardiac function, provide rescue breathing immediately 1, 2
• Follow standard ACLS protocols without modification for electrical injury victims, using synchronized cardioversion starting at 100 J for unstable monomorphic ventricular tachycardia with pulses, and unsynchronized high-energy shocks for pulseless ventricular tachycardia or ventricular fibrillation 1

Special consideration for lightning strikes: When multiple victims are struck simultaneously, prioritize patients in respiratory or cardiac arrest first - this reverses normal triage principles because lightning victims may have spontaneous return of cardiac activity but continued respiratory arrest requiring ventilatory support to prevent secondary hypoxic cardiac arrest 1, 2

Airway Management

• Consider early intubation for patients with extensive burns, particularly those involving the face, mouth, or anterior neck, due to potential for rapid soft-tissue swelling 1, 2, 3
• Administer 100% oxygen immediately 1
• Use caution with all airway control measures due to potential cervical spine injury and soft-tissue swelling 1
• If vomiting occurs during resuscitation, turn the victim to the side and remove vomitus; if spinal cord injury is suspected, logroll the victim 1, 2

Fluid Resuscitation and Shock Management

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

Cardiac Monitoring and Arrhythmia Management

• Establish continuous cardiac monitoring immediately - cardiac arrhythmias including ventricular fibrillation, ventricular asystole, and ventricular tachycardia may result from both low and high-voltage current 1, 3
• Alternating current (AC) is more dangerous than direct current (DC) because it causes tetanic muscle contractions that "lock" victims to the electrical source and increases likelihood of inducing ventricular fibrillation during the vulnerable period of the cardiac cycle 1
• Follow standard ACLS protocols for managing arrhythmias without modification 1

Burn Assessment and Documentation

• 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

• Never underestimate injury severity based on visible skin damage - electrical injuries often cause extensive internal damage that does not correlate with external appearance 2, 3
• Never fail to establish cardiac monitoring - missed arrhythmias are a significant cause of mortality 2, 3
• Never delay resuscitation to obtain blood samples or perform non-essential assessments 4
• Never approach the victim while power remains on, even if they appear to need immediate help 1