Management of Electric Shock

Immediate Resuscitation and Assessment

The American College of Cardiology recommends assessing for cardiac arrest immediately upon safe access to the victim, and if unresponsive and not breathing, begin standard CPR using the C-A-B sequence without delay 1, 2, 3
Attach an automated external defibrillator (AED) as soon as available, as ventricular fibrillation is the most common cause of immediate death from electrocution 1, 2, 3
For victims with isolated respiratory arrest but maintained cardiac function, provide rescue breathing immediately, particularly critical in lightning strike victims who may have spontaneous cardiac recovery but persistent respiratory failure requiring ventilatory support 1, 2, 3

The American Heart Association recommends delivering unsynchronized shocks at 200 J, 200 J, then 360 J in rapid sequence within 30-45 seconds for ventricular fibrillation or pulseless ventricular tachycardia 4, 5, 6
For unstable monomorphic ventricular tachycardia with a pulse, use synchronized cardioversion starting at 100 J 4, 1

Consider early intubation for patients with extensive burns involving the face, mouth, or anterior neck due to risk of rapid soft-tissue swelling that can compromise the airway 1, 2, 3

Obtain a 12-lead ECG within 10 minutes of first medical contact to assess for arrhythmias and cardiac injury 2, 3
Continue continuous cardiac telemetry monitoring for at least 24 hours, as delayed arrhythmias can occur 1, 2, 3

Initiate aggressive IV crystalloid resuscitation immediately with 0.9% normal saline as first-line therapy to counteract shock and facilitate excretion of myoglobin, potassium, and other tissue breakdown products 1, 2, 3
Administer fluid boluses of 250-1000 mL with reassessment after each bolus to ensure adequate resuscitation while preventing fluid overload 1, 2

Obtain comprehensive laboratory panel immediately including complete blood count, comprehensive metabolic panel with electrolytes, renal function tests, coagulation studies, and capillary glucose 2, 3
Document total body surface area (TBSA) affected using the Lund-Browder method, which is more accurate than other assessment methods 1, 2

Admit all patients with high-voltage exposure (>1000V), abnormal initial ECG, cardiac arrest requiring resuscitation, burns >10% TBSA, deep tissue injury, or concomitant traumatic injuries 2, 3

Consider multimodal analgesia combining non-opioid analgesics, antihyperalgesic drugs (ketamine), and opioids during surgical management to prevent prolonged pain 1

Never delay resuscitation to obtain blood samples or perform non-essential assessments 3
Do not underestimate injury severity based on visible skin damage, as internal tissue destruction is often far more extensive than external appearance suggests 1, 2
Do not fail to monitor cardiac function continuously, as arrhythmias are a significant cause of mortality and can occur in a delayed fashion 1