9.20. INJURIES AS A RESULT OF ELECTRIC CURRENT

Related titles

Electrical burns, electric shock.

Aims of assistance

1. Prevention of further injury.
2. Detection of emergency conditions such as arrhythmia or cardiac arrest.
3. Determining the characteristics of the electric current source for transmitting information to the receiving department (voltage, amperage, alternating versus direct current).
4. Understanding that the depth of damage may be greater than external manifestations.
5. Determination of possible concomitant injuries due to the victim being thrown during an electric shock.
6. Determination of the appropriate place of hospitalization, taking into account the fact that the victims may have burn injuries and traumatic injuries.

Description of the patient

Inclusion criteria

Electrocurrent shock (direct or variable).

Exclusion criteria

Absent.

Providing assistance to the patient

Status assessment

1. Make sure the scene is safe. Power source must be turned off before inspection.
2. Perform an initial examination focusing on the detection of arrhythmia or circulatory arrest – use a cardiac monitor.
3. Identify all damaged areas. If the patient was part of the circuit, the additional damage would be near the point of contact with the ground – electrical burns tend to penetrate deep into tissue and cause significant tissue damage.
4. Assess for associated injuries and find out if the patient has been knocked back due to electric shock – in case of loss of consciousness, it should be assumed that the victim has an injury, and appropriate care should be provided.
5. Assess the potential presence of limb compartment syndrome due to damage to limb tissues.
6. Determine the characteristics of the current source – voltage, power, direct or alternating current, damage time.

Treatment and intervention

1. Detect arrhythmias or cardiac arrest – even patients who appear dead (especially with dilated pupils) may have good outcomes with surgery (see relevant guideline for more information and patient assessment/management).
2. Carry out immobilization in the presence of relevant accompanying injuries (see instructions in the section “Injury”).
3. Apply dry bandages to the affected areas.
4. Remove all jewelry and restrictive clothing due to the risk of possible swelling.
5. Provide infusion therapy in a volume according to the area of the burn surface and the patient’s condition – remember that appearance does not give a full understanding of the depth of tissue damage.
6. Electrical injuries are accompanied by severe pain, so anesthetize the patient according to the “Pain Control” guideline.
7. Patients with electrical injuries should be admitted to a burn center as needed, as these injuries can cause significant tissue damage.
8. In the presence of a serious concomitant injury, it is given higher priority than burns, especially if the burn center and the trauma department are in different locations.

Patient safety

1. Make sure there are no additional threats to the patient.
2. Turn off the source.
3. Move the patient to a safe place, if necessary.

Useful information for training

Key points

1. Electric current causes tissue damage through three mechanisms:

a) direct damage, changing the resting membrane potential, causing titania of skeletal and/or cardiac muscle;
b) conversion of electrical energy to heat, causing cell death and coagulation necrosis;
c) mechanical injury as a result of a direct impact from a fall or muscle spasm.

2. Suspect the presence of arrhythmia, as well as cardiac arrest.

3. Mortality due to electric shock depends on several factors:

a) the path of the current passes through the body – the current passing through the heart has a higher risk of fatal consequences;
b) the type of current – constant or alternating:

• • • • alternating current causes arrhythmia, and direct current – deep tissue burns, but both types of current can cause different types of damage;
      • direct current usually causes one muscle contraction, and alternating current can cause repeated contractions;
      • alternating current most often causes ventricular fibrillation, and direct current most often causes asystole;

c) current strength (amperes) has a greater effect on mortality than voltage (volts)

 

Source https://www.osha. gov/SLTC/etools/construction/electrical_incidents/eleccurrent.html

Corresponding evaluation results

1. Identification of accompanying trauma.
2. Presence of arrhythmia.

Key elements of documentation

1. Characteristics of electric current.
2. Duration of stay in this state, provided cardiac arrest is detected.
3. Position of the patient in relation to the current source.
4. Detailed description of external damage.
5. Presence or absence of associated injuries.

Criteria for the effectiveness of aid provision

1. Confirmation of the safety of the scene.
2. Document description of current and voltage (if possible).
3. Documentary description of heart rhythms.
4. Documentary description of the provision of appropriate assistance in case of injuries.