Page 21 - 2023 SMOG Digital

Trauma

ELECTRICAL INJURY

Signs and Symptoms: Differential Diagnosis:
• Burns • Cardiac Arrest
• Pain • Environmental Exposure
• Arrhythmia • Seizure
• Loss of Consciousness • Burns
• Entry/Exit Wounds • Multiple Trauma
• Shock/Hypotension
• Cardiac Arrest
Continued from: Ensure: Universal Patient Care Guideline
Tactical Evacuation Scene Safety O2 (if Hypoxemic)
Guideline (power off, IV/IO Guideline
no water) Cardiac Monitor (ASAP)
Lightning Strike?
Spinal Immobilization Guideline (or other source of massive
direct current)
Bradycardia with Pulse Guideline 12-Lead EKG
Reverse Patient Triage
Cardiac Arrest Guideline Arrythmia? (Heart restarts easier than
breathing *See Pearls)
Tachycardia with Pulse Guideline IVF Bolus pprn n
r
BURN Guideline
Full Evaluation for Injuries
HEAD INJURY Guideline
Treat / Dress Wounds
(per appropriate Guideline) MULTIPLE TRAUMA Guideline

Pain Management Guideline HYPOTENSION / SHOCK Guideline

Pearls:
• Ventricular fibrillation (in AC) and asystole (in DC) are the most common dysrhythmias seen with
electrical shock.
• Damage is often hidden deep as current follows conductive structures (e.g., blood vessels, nerves, muscle).
• In mass casualty situations where lightning is involved – reverse triage should be performed. Those
victims in full arrest should be resuscitated first. The reason for this is the respiratory center of the
brain takes longer to recover from the shock than the heart and respiratory support during this
period can lead to survival.
o Specifically, if there are no spontaneous respirations after airway maneuver, but no other signs of
non-survivable injury, administer ventilatory support aggressively as personnel resources allow.
• Do not overlook secondary trauma.
• Electrical shock victims do not “store” electricity and are safe to handle if current is off.
• Many electrical injury patients will also have significant burn injuries – do not overlook fluid resuscitation.

21