Management Outside of the Hospital

Manmade Electric Current

Patients should be managed as with other emergencies. It is important to keep personal safety in mind and ensure the rescuer does not become the patient. Patients in contact with a source of electricity can conduct electricity to another person. Additionally, the local area can conduct electricity if it is high voltage, including the surrounding ground. The source of power must be off before attempting to get near or touch the patient. 

The initial treatment is to disconnect the patient from the source of current. In work-related incidents in which the utility worker is up on a pole, workplace protocols must be followed, and only trained personnel should attempt this. In recreational settings, the best step is to turn off the power, either using the switch or unplugging the appliance. Ensure that you do not contact any conducting material- use one hand and do not touch anything else. If this cannot be done safely, turn off the circuit breaker or turn of power at the fuse box. The patient can be safely touched once the power is off. In the case that the power cannot be turned off, it is possible to use insulation to pull the patient from the source or use a pole that is dry to move the patient. Both options should be done very cautiously. 

Lightning

Unlike with manmade electric current, the patient struck by lightning will no longer be connected to the energy source. However, if there is persistent inclement weather, the responders may be at risk. Move the patient to a safe indoor space to provide resuscitation. The primary focus should be managing a patient in respiratory or cardiac arrest as immediate resuscitation can save the patient’s life. If multiple patients are present, treat those in arrest first. 

Basic Management of the patient

 Treat patients in arrest with early resuscitation as rapid efforts can increase survival more than in other arrests not associated with VF. Resuscitation can also be successful after a prolonged collapse or persistent arrest. Once the scene if safe, the priority should be maintaining adequate oxygenation of the heart and brain in the cardia arrest patient. Provide CPR and obtain and use the AED quickly. Evaluate for any spinal cord injury and use spinal precautions if there is a warranted suspicion for injury.  Be aware that associated injuries and burns may occur. Remove any singed or smoking clothing to prevent burns. As many patients are young and otherwise healthy, there can be a good chance of survival if early resuscitation is provided.  

Advanced Management of the patient

Advance management should proceed as with other emergent cases. Be cautious of possible spinal cord injury or burns to the face, mouth, or neck that can all make airway management more challenging. Note that these burns may cause significant swelling of adjacent tissues, and early advanced airway management may be prudent. Patients with extensive burns will need rapid IV hydration, as these can lead to hypovolemia and distributive shock. Monitor urine output and be ready to provide significant fluid volume if there is ongoing muscle and tissue damage.

Patients may have much more extensive internal electrical injuries than what is readily apparent. These injuries can lead to long-term cardiac and neurologic impairment. Patients may need early evaluation and management by burn physicians and others who are familiar with the care of such injuries. 

Triaging for multiple lightning patients 

The lighting patient in cardiac or respiratory arrest requires immediate resuscitation for a chance of survival. On the other hand, patients with adequate respiration and perfusion will likely maintain hemodynamic and pulmonary stability and not require significant interventions. 

Management in the Hospital

Patients may need advance management of cardia arrest with airway, ventilatory and cardiac management as well as advanced imaging and intervention. Associated traumas and burns will also require treatment. Care by an interdisciplinary team of surgeons, critical care physicians, neurology, and cardiology will be key to managing all aspects of the patient’s care. 

Damaged tissue will swell, and there may be subsequent compartment syndrome if significant burns are present. This can further cause tissue damage and vascular compromise. Consult with burn surgeons early to ensure no need for surgical debridement.