Download Electrocution/ electric shock

Electrocution/ electric shock
Recommend
 See Immediate management
 The severity of the injury and risk of death is greatest with

high voltage electricity(eg lightning, power lines)

low resistance (eg wet skin)

electrical pathway across the heart

prolonged exposure [5]
Background
 The electrical charge causes an entry wound (burn) that is often full thickness, with potential underlying
tissue damage that may be extensive and not immediately apparent. There is a similar exit (earthing)
burn
 If the charge crosses the heart, arrhythmias including cardiac arrest (ventricular fibrillation)
may occur, and if it crosses the brain, unconsciousness may occur
Related topics:
 DRABC Resuscitation / the collapsed patient, page 35
 Severe injuries, page 95
 Burns, page 147
1.
May present with:
 History of exposure to high or low voltage electricity (household or industrial)
 Superficial cutaneous burns [5]
 Deep tissue injury [5]
 Seizures, confusion, drowsy, loss of consciousness
 Cardiac arrest (due to ventricular fibrillation)
2.
Immediate management:
 Remove patient from injury (only approach patient or surroundings after power is turned off at
mains)
DRABC Resuscitation / the collapsed patient
 Give high flow oxygen (see O2 Delivery systems) to maintain O2 saturation >94%. If >94% not
maintained consult MO
 Connect to ECG monitor / defibrillator
 BP / heart rate / respirations / O2 saturation / conscious state
 Insert IV cannula
 Consult MO
3.
Clinical assessment:
 Obtain emergency patient history - circumstances of injury – type of electrical exposure, any
cardiopulmonary resuscitation measures implemented
 Perform standard clinical observations
 Monitor and act on any changes in conscious state (see Glasgow coma scale or AVPU)
 Perform physical examination
 inspect skin for entry wound (burn) and exit (earthing) burn
4.
Management:
 Do 12 lead ECG and fax to MO
 See Burns
5.
Follow up:
 If there has been no history of altered consciousness or cardiac arrhythmia and the ECG is normal,
the patient need not be evacuated/hospitalised and can be allowed home after a few hours of
observation provided only minor burn(s)
 See Burns, review daily initially for 2-3 days
 See next MO clinic
6.
Referral / Consultation:
 Consult MO on all occasions of:
 electrocution / electric shock / electrical burns
 Referral to specialist burns unit patients with suspected deep tissue electrical injury [5]