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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]