Electrocution/Electrical Injury BLS PCS Standard

True or false: the paramedic should make an attempt to touch the patient still in contact with a potential energized source (and/or touch the source itself) for swiftness of intervention

false

True or false: if there are multiple patients as a result of a lightning strike, focus efforts on those who are VSA due to their high potential for resuscitation

true

What are the life/limb/function threats that should be considered in electrocution/electrical injury cases?

• cardiopulmonary arrest

• dysrhythmias

• extremity neurovascular compromise

• multiple and/or severe trauma

• seizures

• significant internal tissue damage

True or false: the paramedic should make an attempt to determine the type of current and the voltage

true

What are signs of significant electrical injury?

• burns

• cold/mottled/pulseless extremities

• dysrhythmias

• entry/exit wounds

• muscle spasms

• neurologic impairment

• shallow, irregular respirations

What should be done if a limb/extremity has neurovascular compromise after an electrocution/electrical injury?

• place sterile, dry dressing over any visible burn sites

  • do NOT apply constrictive bandages

• re-assess distal neurovascular status in the affected extremity approximately every 10 minutes if status was compromised on initial assessment

True or false: severe, deep muscle swelling from electrical thermal energy often leads to acute compartment syndrome

true

What are indications of acute compartment syndrome?

• pain with passive stretch in the affected extremity

• disproportionate pain response to touching affected extremity

What are the potential problems the paramedic should be prepared for in electrocution/electrical injury cases?

• dysrhythmias

• extremity neurovascular compromise

What are some of the mechanisms of damage behind acute compartment syndrome after electrocution/electrical injury?

• internal electro thermal burning

  • coagulation necrosis (tissue cooking) along the path of the current

• massive inflammatory edema

  • cellular leaking from coagulation necrosis

  • fluid shifts from severe inflammatory response

• vascular congestion/blood clots

  • caused by vessel damage

  • thrombosis/widespread blood clotting

What is acute compartment syndrome?

human limbs are divided into closed compartments encased by tough, unyielding tissue walls (fascia), therefore, any internal swelling rapidly triggers a dangerous pressure build-up → electrical injury causes inflammation

What is the ischemic cascade?

• high pressure collapses the small veins and capillaries first, cutting off oxygen delivery

• this lack of oxygen kills more muscle cells, which swell even further, creating a self-perpetuating cycle that eventually cuts off major arterial blood flow entirely