Notes – Electrical Injuries

Electrical Injuries

Patient Safety Considerations

1. Verify no additional threat to patient
2. Shut off electrical power
3. Move patient to shelter if electrical storm activity still in area

Notes/Educational Pearls

Key Considerations

1. Electrical current causes injury through three main mechanisms:
   1. Direct tissue damage, altering cell membrane resting potential, and eliciting tetany in skeletal and/or cardiac muscles
   2. Conversion of electrical energy into thermal energy, causing massive tissue destruction and coagulative necrosis
   3. Mechanical injury with direct trauma resulting from falls or violent muscle contraction
2. Anticipate atrial and/or ventricular dysrhythmias as well as cardiac arrest
3. The mortality related to electrical injuries is impacted by several factors:
   1. Route current takes through the body – current traversing the heart has higher mortality
   2. Type of current – AC vs. DC
      1. AC is more likely to cause cardiac dysrhythmias while DC is more likely to cause deep tissue burns however either type of current can cause any injury
      2. DC typically causes one muscle contraction while AC can cause repeated contractions
      3. Both types of current can cause involuntary muscle contractions that do not allow the victim to let go of the electrical source
      4. AC is more likely to cause ventricular fibrillation while DC is more likely to cause asystole
   3. The amount of current impacts mortality more than the voltage

Pertinent Assessment Findings

1. Identification of potential trauma concomitant with electrical injury
2. Presence of cardiac dysrhythmias

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

• 9914095 – Injury-Electrical Injuries

Key Documentation Elements

• Characteristics of electrical current
• Downtime if found in cardiac arrest
• Positioning of the patient with respect to the electrical source
• Accurate description of external injuries
• Document presence or absence of associated trauma

Performance Measures

• Confirmation of scene safety
• Documentation of electrical source and voltage if known
• Documentation of cardiac monitoring
• Documentation of appropriate care of associated traumatic injuries
• EMS Compass® Measures (for additional information, see http://www.emscompass.org)
  • Trauma-01: Pain assessment of injured patients. Recognizing that pain is undertreated in injured patients, it is important to assess whether a patient is experiencing pain
  • Trauma-02: Pain re-assessment of injured patients. Recognizing that pain is undertreated in injured patients, it is important to assess whether a patient is experiencing pain
  • Trauma-04: Trauma patients transported to trauma center. Trauma patients meeting Step 1 or 2* or 3** of the CDC Guidelines for Field Triage of Injured Patients are transported to a trauma center
    • * Any value documented in NEMSIS eInjury.03 – Trauma Center Criteria
    • ** 8 of 14 values under eInjury.04 – Vehicular, Pedestrian, or Other Injury Risk Factor match Step 3, the remaining 6 value options match Step 4

References

1. Electrical Injuries. Emedicince.medscape.com. http://emedicine.medscape.com/article/433682-overview. Updated February 8, 2017. Accessed August 29, 2017.
2. Pham TN, Gibran NS. Thermal and electrical injuries. Surg Clin North Am. 2007;87(1):185-206.
3. Price TG, Cooper MA. Electrical and lightning injuries. In Hockenberger R, ed. Rosen’s Emergency Medicine, 7th Edition. 2009.