From the Guidelines
The initial workup for electrical shock should include a thorough assessment of vital signs, cardiac monitoring, and evaluation for both visible and internal injuries. Begin with ABCs (airway, breathing, circulation) and immediately place the patient on continuous cardiac monitoring, as arrhythmias can develop even hours after the shock, as noted in the guidelines for first aid 1. Obtain a 12-lead ECG and cardiac enzymes to assess for myocardial damage, considering that cardiac arrhythmias, including ventricular fibrillation, ventricular asystole, and ventricular tachycardia, may result from exposure to low- or high-voltage current 1.
Key Components of the Workup
- Laboratory tests should include complete blood count, comprehensive metabolic panel, creatine kinase, and urinalysis to check for myoglobinuria indicating muscle breakdown.
- Imaging should be guided by clinical presentation - consider chest X-ray for respiratory symptoms and CT scans for patients with altered mental status or suspected internal injuries.
- For high-voltage injuries (>1000V) or any patient with loss of consciousness, cardiac abnormalities, or significant burns, hospital admission for 24-hour monitoring is recommended, given that cardiopulmonary arrest is the primary cause of immediate death from electrocution 1.
Management Considerations
- Fluid resuscitation with isotonic crystalloids should be initiated for patients with significant burns or evidence of rhabdomyolysis, with a target urine output of 0.5-1 mL/kg/hr.
- It is crucial to prioritize caution and ensure the power is turned off before approaching the victim to prevent further injury, as all materials can conduct electricity if the voltage is high enough 1. This comprehensive approach is necessary because electrical injuries can cause damage that isn't immediately apparent, with current potentially causing internal tissue destruction along its path through the body while the skin may appear relatively unharmed.
From the Research
Electrical Shock Workup
- The workup for electrical shock involves identifying the underlying cause of the shock, which can be a complex and life-threatening condition 2.
- Electrical shock can cause immediate damage to the heart, nervous system, and musculoskeletal system, as well as delayed complications days to years later 3.
- The initial assessment of a patient with electrical shock should include a thorough physical examination, laboratory tests, and imaging studies to identify any underlying conditions that may be contributing to the shock.
- Laboratory tests such as a basic metabolic panel can help identify electrolyte imbalances and renal function, which can be affected by electrical shock 4.
- An electrocardiogram (ECG) can also be used to diagnose and manage patients with acute coronary syndromes, which can be a complication of electrical shock 5.
Diagnostic Signs and Symptoms
- The clinical and diagnostic signs of shock can include hypotension, tachycardia, and decreased urine output 6.
- Patients with electrical shock may also exhibit symptoms such as headaches, dizziness, pain, nausea, and blurred vision 3.
- A thorough neurological examination, including MRI and EEG, may be necessary to evaluate the extent of the injury 3.
Management and Treatment
- The management of electrical shock involves aggressive targeted intervention to reduce morbidity and mortality 6.
- Treatment options may include correction of electrolyte imbalances, management of pain and inflammation, and rehabilitation to address musculoskeletal manifestations 3, 4.
- Nursing interventions can play an important role in managing the care of patients with electrical shock, including monitoring of vital signs, administration of medications, and provision of emotional support 2.