Management

management

The first step is to turn off the electrical source safely in order to avoid further accidents. Once the patient is safe, manage according to the symptoms.

• perform basic life support
  • prompt and sometimes prolonged resuscitation attempt is warranted
    • immediate resuscitation is vital since it can result in long term survival in patients with cardiac arrest from electrocution
    • furthermore complete recovery has been reported even after prolonged life support
  • standard life support principles should be used
  • IV hydration is recommended to prevent kidney shut down even in the absence of low blood pressure
• look for clinical signs to assess effects of electrical current on the patient’s body
  • if there is extensive burns - admit patient to burns unit
  • pregnant women should be admitted to obstetrics for fetal cardiac monitoring
  • identify the entry and exit points to determine which organs could be damaged
• the following patients should be admitted to the hospital for continuous ECG monitoring and further management
  • with initial loss of consciousness
  • cardiac anomalies
  • high voltage injury

Discharging the patient:

• low voltage accidents
  • in the absence of loss of consciousness or initial cardiac arrest - patient can be discharged since episodes of arrhythmia is unlikely if the ECG on admission was normal
• high voltage accidents
  • monitor ECG for at least 24 hour
    • patients should be educated about delayed cardiac arrhythmias which may rarely lead to sudden death
  • discharge if arrhythmia free for at least 24 hours (1)

Reference:

• (1) Waldmann V et al. Electrical injury. BMJ. 2017;357:j1418