Electrical Injuries

Question 1

Electrical Injuries - Definition

Answer 1

Injuries resulting from contact w/ high voltage electrical current

Question 2

Goal of Care

Answer 2

Assessment and treatment of all injuries; rapid transport

Question 3

Overview

Answer 3

Electrical injs are associated w/ contact w/ live electrical current. Injuries most often happen in the workplace in adults and at home in children.
The extent of electrical injs can be very broad, ranging from minimal inj to extensive multi-organ involvement, w/ both hidden and delayed complications as well as death

Question 4

Low Voltage Injuries vs High Voltage Injuries

Answer 4

Low voltage - <500 volts
High voltage - >500 volts

In general, electrical energy trauma may result in the following injuries:

• Direct tissues trauma due to the passage of current. This results in damage to bone, muscle, nerve and soft tissues and is seen mainly w/ high voltage current
• Electric effect on the brain leading to loss of consciousness and respiratory arrest
• Affect of current to the heart leading to V-fib

Trauma secondary to being thrown or falls post electric injury

Question 5

Special Note 1

Answer 5

Electrical energy trauma is often associated w/ hazardous environment that threatens the safety of subsequent responders

Scene safety is paramount prior to reaching a victim of severe electrical injury

Question 6

Guiding Principles

Answer 6

• ABCs, as always, are the priority. Initiate CPR as required
• Assess for presence of any inj, either burns associated w/ entry or exit points or secondary inj associated w/ falls or being thrown
• Attempt to gather information on the type/duration of current
• Pt comfort and protection of any inj’d limb may be all that is required
• For high voltage inj, IV fluids w/ 500c bolus NS then 100mL for those w/ no sign of shock
• Follow the treatment guideline for shock for those pts who are hypotensive w/ signs of hypoperfusion
• Pts w/ high voltage inj or those w/ an associated ALOC or dysrhythia should be placed on a cardiac monitor

Question 7

Causes

Answer 7

• Accidental contact w/ live electrical lines
• Accidental contact w/ ungrounded appliances w/ an electrical short circuit
• Electrical cord biting in infants
• Lightning strikes

Question 8

Intervention Guidelines - EMR

Answer 8

EMR
Ensure scene safe from live electrical power
Flush and decontaminate affected area w/ sterile saline
Do not cool burns longer than 1-2mins including decontamination time
Dress injuries as required
Identify type of current and duration of contact
Rapid transport
Analgesia
- Entonox - self admin to effect

Question 9

Intervention Guidelines - PCP/ACP

Answer 9

PCP
All above, plus
IV therapy enroute
- High voltage - 500cc bolus then maintain 100cc/hr if no signs of shockt
- NS up to 2L - reassess BP/lungs every 500cc

ACP
Monitor for and correct rhythm disturbances
Intubation as per AIG
Analegsia as required
 - Morphine - 2.5mg IV effect