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Electric Shock - Treatment

When an electric current passes through the body, the damage it does depends on the intensity of the current (amperes, milliamperes, or microamperes), the resistance of the tissues it passes through, the kind of current (alternating current, direct current, or mixed), and the frequency and duration of current flow.

Electric shock may cause ventricular fibrillation, respiratory paralysis, burns, and death. The prognosis depends on the site and extent of damage, the patient's state of health, and the speed and adequacy of treatment. Each year, about 1,000 persons in the United States die of electric shock.

Causes

Electric shock usually follows accidental contact with exposed parts of electrical appliances or wiring, but it may also result from lightning or the flash of electric arcs from high-voltage power lines or machines.

The increased use of electrical medical devices in the hospital, many of which are connected directly to the patient, has raised serious concern for electrical safety and has led to the development of electrical safety standards. However, even well-designed equipment with reliable safety features can cause electric shock if it's mishandled.

Signs and symptoms

The typical symptoms of an electric shock include:

• Unconsciousness
• Difficulties in breathing or no breathing at all
• A weak, erratic pulse or no pulse at all
• Burns, particularly entrance and exit burns (where the electricity entered and left the body).

Diagnosis

Diagnosis relies on gathering information about the circumstances of the accident, a thorough physical examination , and monitoring of cardiovascular and kidney activity. The victim's neurological condition can fluctuate rapidly and requires close observation. A computed tomography scan (CT scan) or magnetic resonance imaging (MRI) may be necessary to check for brain injury.

Treatment

Immediate emergency treatment includes carefully separating the victim from the current source, quickly assessing vital functions, and instituting emergency measures, such as cardiopulmonary resuscitation (CPR) and defibrillation.

To separate the victim from the current source, immediately turn it off or unplug it. If this isn't possible, pull the victim free with a nonconductive device, such as a loop of dry cloth or rubber, a dry rope, or a leather belt.

Emergency measures

Then begin emergency treatment as follows.

• Quickly assess vital functions. If you don't detect a pulse or breathing, start CPR at once. Continue until vital signs return or emergency help arrives with a defibrillator and other life-support equipment. Then monitor the patient's cardiac rhythm continuously and obtain a 12-lead electrocardiogram.
• Because internal tissue destruction may be much greater than indicated by skin damage, give lactated Ringer's solution I.V. to maintain a urine output of 50 to 100 ml/hour. Insert an indwelling urinary catheter, and send the first specimen to the laboratory.
• Measure intake and output hourly, and watch for tea- or port wine-colored urine, which occurs when coagulation necrosis and tissue ischemia liberate myoglobin and hemoglobin. These proteins can precipitate in the renal tubules, causing tubular necrosis and renal shutdown. To prevent this, give mannitol and furosemide.

Prevention

• Do not allow children to play with any electrical cord.
• Use outlet covers to protect infants from exploring electrical outlets.
• Teach your children about the dangers of electricity.
• Avoid using electrical appliances while showering or wet.
• Tell patients how to avoid electrical hazards at home and at work. Advise parents of young children to put safety guards on all electrical outlets and keep children away from electrical devices. Warn all patients not to use electrical appliances while showering or wet.
• Warn patients never to touch electrical appliances while touching faucets or cold water pipes in the kitchen because these pipes often provide the ground for all circuits in the house.