What is the hospital management for electrocution?

Hospital Management for Electrocution

All electrocution victims require immediate cardiac monitoring with 12-lead ECG within 10 minutes of arrival, aggressive IV crystalloid resuscitation with 0.9% saline for those with significant tissue injury, and continuous cardiac monitoring for at least 24 hours to detect potentially fatal arrhythmias. 1, 2

Immediate Assessment and Stabilization

Primary Survey and Cardiac Evaluation

• Obtain a 12-lead ECG within 10 minutes of hospital arrival to assess for arrhythmias and cardiac injury 2
• Assess for cardiopulmonary arrest and initiate standard CPR with C-A-B sequence if the patient is unresponsive and not breathing 2
• Attach an AED immediately and prepare for defibrillation if indicated 2
• Cardiac arrhythmias including ventricular fibrillation, ventricular asystole, and ventricular tachycardia may occur from both low and high-voltage exposure 1, 2

Airway Management

• Consider early intubation for patients with extensive burns, particularly involving the face, mouth, or anterior neck due to risk of airway compromise from soft-tissue swelling 1, 2
• Use caution with airway control measures as soft-tissue swelling can progress rapidly 2

Fluid Resuscitation Protocol

Initial Fluid Management

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

Monitoring Resuscitation Response

• Evaluate response by measuring lactate levels, aiming for a 20% reduction in the first hour 1
• Monitor clinical signs of tissue perfusion continuously 1
• Interrupt fluid resuscitation when no improvement in tissue perfusion is observed in response to volume loading 1
• Watch for signs of fluid overload, particularly pulmonary edema 1

Vasopressor Support

• Consider vasopressors (such as norepinephrine) if hypotension persists despite adequate fluid resuscitation 1

Cardiac Monitoring and Arrhythmia Management

Duration and Indications

• Continue cardiac monitoring for at least 24 hours or until an alternative diagnosis is made 2
• Cardiopulmonary arrest is the primary cause of immediate death from electrocution, making cardiac monitoring essential 1, 2

Arrhythmia Treatment

• Use synchronized cardioversion starting at 100 J for unstable monomorphic ventricular tachycardia with pulses 2
• Use unsynchronized high-energy shocks for pulseless ventricular tachycardia or ventricular fibrillation 2
• No modifications to standard ACLS protocols are required for electrical injury victims, except attention to possible cervical spine injury 2

Special Consideration for Lightning Strikes

• Lightning strike victims may experience spontaneous return of cardiac activity but continued respiratory arrest, requiring ventilatory support to prevent secondary hypoxic cardiac arrest 2

Laboratory and Diagnostic Workup

Initial Laboratory Tests

• Obtain complete blood count, electrolytes, renal function, coagulation studies, and capillary glucose level 2
• Monitor for rhabdomyolysis with creatine kinase and myoglobin levels 1
• Serial troponin measurements to assess for myocardial injury 2

Burn Assessment

• Use the Lund-Browder method for documenting total body surface area (TBSA) affected, as it is more accurate than other assessment methods 1
• Remember that the extent of injury often does not correlate with visible skin damage in electrical burns 1

Temperature Control and Tissue Protection

Active Cooling Measures

• Temperature control is the intervention that decreases the zone of stasis in electrical burn injuries to prevent tissue necrosis 3
• Active cooling prevents coagulum formation and reduces ongoing thermal injury at the tissue level 3
• Avoid hyperthermia in the post-injury period, as elevated temperature accelerates tissue destruction 3

Critical Pitfalls to Avoid

Assessment Errors

• Never underestimate injury severity based on visible skin damage alone, as internal tissue destruction may be extensive 1
• Do not delay resuscitation to obtain blood samples or perform non-essential assessments 2

Monitoring Failures

• Failure to monitor cardiac function can result in missed arrhythmias, which are a significant cause of mortality 1
• Do not discontinue cardiac monitoring prematurely, as delayed arrhythmias can occur 2

Fluid Management Mistakes

• Avoid hypotonic solutions like lactated Ringer's, which can increase tissue edema in patients with electrical injuries 1
• Do not continue aggressive fluid resuscitation when signs of fluid overload develop 1

Disposition and Ongoing Care

Admission Criteria

• All patients with abnormal ECG findings require admission and continuous cardiac monitoring 2
• Patients with significant tissue destruction or burns require admission for ongoing fluid management 1
• Those with respiratory compromise or altered mental status require ICU-level care 1

Observation Period

• Minimum 24-hour observation with cardiac monitoring is recommended for all significant electrical injuries 2
• Extended monitoring may be necessary based on initial findings and clinical course 2