What is the treatment plan for a 50-year-old male with electric shock?

Treatment Plan for a 50-Year-Old Male with Electric Shock

Immediate Scene Safety and Initial Assessment

Ensure the power source is completely turned off before approaching the victim—never touch an electrocution victim while power is on, as this places rescuers at risk. 1

• Turn off power at the source (typically near the fuse box in homes) 1
• For high-voltage incidents involving fallen power lines, immediately notify emergency services (911) and do not enter the area until power is confirmed off by qualified personnel 1
• All materials conduct electricity at sufficiently high voltage, so do not attempt wire removal with any object, including wooden ones, until power is disconnected 1

Primary Survey and Resuscitation

Once the scene is safe, immediately assess for cardiopulmonary arrest and initiate standard CPR with defibrillation if needed, as cardiopulmonary arrest is the primary cause of immediate death from electrocution. 1, 2

Cardiac Assessment and Management

• Assess for pulse and breathing immediately 2
• If pulseless, begin high-quality CPR using standard C-A-B sequence (compressions-airway-breathing) 2
• Attach automated external defibrillator (AED) or manual defibrillator as soon as available 1, 2
• Treat ventricular fibrillation, ventricular asystole, or pulseless ventricular tachycardia per standard ACLS protocols without modification 1, 2
• For unstable monomorphic ventricular tachycardia with pulse, use synchronized cardioversion starting at 100 J 2
• For pulseless VT or polymorphic VT, deliver unsynchronized high-energy shocks (defibrillation doses) 2

Airway Management

Consider early intubation for patients with burns involving the face, mouth, or anterior neck, as extensive soft-tissue swelling can develop rapidly and complicate delayed airway control. 1, 2

• Establish airway control early, even if the patient has begun breathing spontaneously, when evidence of extensive burns exists 1
• Maintain spinal motion restriction by manually stabilizing the head if trauma is suspected, as cervical spine injury must be considered 1, 2
• If vomiting occurs, turn the victim to the side (logroll if spinal injury suspected) and clear the airway 2

Respiratory Support

• For victims with respiratory arrest but maintained cardiac function, provide immediate rescue breathing 2
• Lightning strike victims may experience spontaneous return of cardiac activity but continued respiratory arrest due to brain injury or respiratory muscle paralysis—ventilatory support is critical to prevent secondary hypoxic cardiac arrest 1, 2

Secondary Survey and Definitive Care

Cardiovascular Monitoring

Obtain a 12-lead ECG within 10 minutes of first medical contact and continue cardiac monitoring for at least 24 hours, as cardiac arrhythmias may be delayed. 2, 3

• Monitor for ventricular fibrillation, ventricular asystole, and ventricular tachycardia, which can result from both low and high-voltage exposure 1, 2
• All victims of electric shock require medical assessment because the extent of injury may not be apparent initially 1

Fluid Resuscitation

For victims with significant tissue destruction who regain a pulse, initiate rapid IV crystalloid (0.9% saline) administration to counteract distributive/hypovolemic shock and facilitate excretion of myoglobin, potassium, and other tissue breakdown products. 1, 2, 4

• Fluid administration should be adequate to maintain diuresis, particularly important for patients with electric injury and tissue destruction 1
• Aggressive IV crystalloid resuscitation (not vasodilators) is the recommended approach 4

Burn Management

• Cool thermal burns with cold (15° to 25°C) tap water as soon as possible and continue until pain is relieved 1
• Do not apply ice directly to burns, as this can produce tissue ischemia 1
• Assess for entry and exit wounds, as thermal burns may be present at these points and along the internal pathway of current 1
• Cover burn blisters loosely with sterile dressing but leave blisters intact 1

Laboratory and Diagnostic Evaluation

• Obtain complete blood count, electrolytes, renal function tests, coagulation studies, and capillary glucose level 2
• Monitor for myoglobin release and renal function, particularly with extensive tissue injury 1

Special Considerations and Pitfalls

Common Pitfalls to Avoid

• Never delay resuscitation to obtain blood samples or perform non-essential assessments 2
• Do not assume the extent of injury based on external appearance alone—internal injuries may be extensive despite minimal external burns 1, 3
• Avoid hyperthermia in the post-injury period, as elevated temperature accelerates tissue destruction 4
• Do not use immobilization devices unless properly trained, but maintain manual spinal stabilization if trauma is suspected 1

Prognosis Considerations

• Victims of electrical shock may have better resuscitation outcomes than other cardiac arrest causes because they are typically younger with less underlying cardiac disease 5
• Prolonged high-quality CPR may be warranted in electrical shock victims, as successful resuscitation has been documented even after 65 minutes of CPR 6
• The severity of electrical injuries varies widely—from minor tingling to fatal cardiopulmonary arrest—requiring thorough evaluation in all cases 1, 2

Multiple Casualty Situations

• When multiple victims are struck simultaneously by lightning, prioritize patients in respiratory or cardiac arrest (reverse normal triage), as these patients have the best chance of survival with immediate intervention 2, 5