Part 8: Advanced Challenges in ResuscitationSection 3: Special Challenges in ECC: 3G: Electric Shock and Lightning Strikes
Section snippets
Electric Shock
Most electric shock injuries to adults occur in the occupational setting [1]. Pediatric electric shock injuries occur most commonly in the home, when the child bites electrical wires, places an object in an electrical socket, contacts an exposed low-voltage wire or appliance, or touches a high-voltage wire outdoors [2].
Electric shock injuries result from the direct effects of current on cell membranes and vascular smooth muscle and from the conversion of electric energy into heat energy as
Clinical Effects
Immediately after electrocution or lightning strike, the victim's respiratory function, circulation, or both, may fail. The patient may be apneic, mottled, unconscious, and in cardiac arrest from VF or asystole.
Respiratory arrest may be caused by a variety of mechanisms:
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Electric current passing through the brain and causing inhibition of medullary respiratory center function
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Tetanic contraction of the diaphragm and chest wall musculature during current exposure
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Prolonged paralysis of respiratory
Modifications of BLS Actions for Arrest Caused by Electric Shock or Lightning Strike
The rescuer must be certain that rescue efforts will not put him or her in danger of electric shock. After the power is turned off by authorized personnel or the energized source is safely cleared from the victim, determine the victim's cardiorespiratory status. Immediately after electrocution, respiration or circulation or both may fail. The patient may be apneic, mottled, unconscious, and in circulatory collapse with VF or asystole.
Vigorous resuscitative measures are indicated, even for those
Modification of ACLS Support for Arrest Caused by Electric Shock or Lightning Strike
Treat VF, asystole, and other serious arrhythmias with ACLS techniques outlined in these guidelines. Quickly attempt defibrillation, if needed, at the scene.
Establishing an airway may be difficult for patients with electric burns of the face, mouth, or anterior neck. Extensive soft-tissue swelling may develop rapidly and complicate airway control measures, such as endotracheal intubation. For these reasons, intubation should be accomplished on an elective basis before signs of airway
References (24)
Electrical and lightning injuries
Emerg Med Clin North Am
(1984)Electrical injuries: pathophysiology and emergency management
Ann Emerg Med
(1982)- et al.
Electrical injuries and lightning
Emerg Med Clin North Am
(1992) - et al.
Myocardial damage associated with electrical injury
Am Heart J
(1989) - et al.
Myocardial injury in electrocution
Am Heart J
(1991) Lightning injuries: prognostic signs for death
Ann Emerg Med
(1980)Lightning and electrical injuries
Neurol Clin
(1992)- et al.
Electrical injuries and lightning
Emerg Med Clin North Am
(1992) - et al.
Cardiovascular effects of lightning strikes
J Am Coll Cardiol
(1993) - et al.
Echocardiographic observations in survivors of acute electrical injury
Chest
(1990)