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Management of Electrical Injury in the Emergency Department - An Overview

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Electrical injuries are often reported in the emergency department, and managing them is difficult. Read the article below to learn more.

Written by

Dr. Neha Rani

Medically reviewed by

Dr. Kaushal Bhavsar

Published At December 7, 2023
Reviewed AtJanuary 10, 2024

Introduction

Healthcare personnel working in emergency departments (ED) have a special and sometimes fatal difficulties when treating electrical injuries. Since the severity of these injuries can range from mild burns to serious systemic consequences, managing them is difficult and diverse. Lightning strikes, household errors, and workplace accidents can all cause electrical injury. Regardless of the cause, prompt and adequate therapy is essential for improving results and reducing problems.

What Is Electrical Injury?

Direct exposure to an electric current can affect skin, tissues, or internal organs, which is referred to as an electrical injury. When a person comes into direct touch with an electrical source, such as a live wire or an electrical appliance, it frequently results in this kind of injury, which can cause anything from minor burns to major inside damage. Depending on variables, including the voltage, current, duration of contact, and direction the electrical current takes through the body, electrical injuries can have a variety of impacts on the human body. These wounds may require urgent medical care since they may cause a number of medical issues.

There are four ways that electric current can harm people:

  • Cardiac arrest as a result of electric current affecting the heart.

  • Damage to muscles, nerves, and tissues as a result of a current moving through the body.

  • Thermal burns are caused by coming into touch with the power source.

  • Falls or injuries brought on by electrical contact.

How Is Electrical Injury Managed in the Emergency Department?

Preliminary Evaluation and Triage:

  • Safety First - Healthcare must prioritize patient safety. Place patient and provider safety first. Before providing any treatment, make sure the power source is turned off and scan the area for dangers. This preventive measure ensures a secure setting, reducing hazards and enabling the effective and safe administration of service.

  • Primary Survey - The initial emphasis during the primary survey is on the ABCs: Airway, Breathing, and Circulation. Make sure the patient has an open airway first, taking care of any blockages or obstructions. In order to increase oxygenation, evaluate breathing to make sure it is enough and deliver oxygen if necessary. Take prompt treatment if necessary after evaluating circulation by looking for a pulse and symptoms of serious bleeding. By addressing life-threatening injuries as soon as possible, ensuring that the patient's important functions remain unharmed, and stabilizing them, this crucial evaluation and stabilization phase seeks to provide the groundwork for additional medical intervention.

  • Analyzing the Electrical Pathway - Identifying the places of entry and departure for electrical current in the body is necessary for evaluating the electrical route. For information on potential interior damage brought on by electrical shock, this assessment is essential. Healthcare providers may more accurately diagnose and treat patients by determining the electrical discharge's exact route and the level of tissue stress and damage.

Stabilization and Care Support:

  • Cardiac Monitoring: In situations of electrical damage, ongoing cardiac monitoring is essential owing to the possibility of delayed arrhythmias. Electrical harm can alter the heart's regular beat and cause potentially fatal abnormalities. Continuous monitoring enables the early identification and treatment of arrhythmias, resulting in safe patient care and fast action.

  • Fluid Resuscitation: Assess for indications of shock and dehydration and provide intravenous fluids as necessary. The goal of fluid resuscitation is to increase tissue perfusion and overall patient stability while restoring an acceptable blood volume. This crucial intervention aids in the healing process by reducing the consequences of shock and fluid loss.

  • Managing Pain: Utilize the right drugs to treat the pain and anxiety, and use opioids with caution because they can cause respiratory depression. Effective pain management strikes a compromise between pain alleviation and safety in light of potential opioid-related dangers, ensuring patient comfort without impairing their ability to breathe.

Diagnosis and Evaluation - A thorough physical examination is necessary to evaluate injuries, especially skin burns, wounds, and neurological issues. This information is crucial for developing a treatment plan that is specifically customized to the patient. Diagnostic imaging, such as X-rays and CT (computed tomography) scans, is essential for finding internal injuries, fractures, or dislocations in cases of high-voltage electrical accidents and providing a full examination.

Wound Management - Prioritize rigorous wound care in situations of electrical burns, which includes thorough cleansing, debridement, and suitable dressing. Whenever necessary, especially in situations where there is a chance of contamination, administer tetanus prophylaxis. These procedures help patients with electrical burns recover quickly and effectively while lowering the risk of infection.

Cardiac Evaluation - Perform a cardiac assessment, starting with an electrocardiogram (ECG) to detect any arrhythmias as soon as possible. Arrhythmias should be managed according to recognized medical standards if they are found. Additionally, keep a close eye on cardiac enzymes like troponin to look for any myocardial damage. Even though there are no obvious symptoms at the time, elevated troponin levels can suggest heart injury. The patient's cardiac care and general recovery after electrical injuries, which may have negative consequences on the heart's electrical and structural function, are optimized thanks to this complete approach's assurance of prompt intervention and customized therapy.

Neurological Examination - Conduct a thorough neurological examination to find any sensory or motor abnormalities that might indicate nerve damage brought on by the electrical event. Conduct a full head injury examination in cases when the electrical damage occurred concurrently with a fall or another type of trauma. This examination attempts to identify and treat any concurrent head injuries or concussions, ensuring a comprehensive assessment of the patient's state and the use of effective treatment approaches for both neurological and head injuries.

Consultation and Admission - Consider consulting with experts like burn surgeons, cardiologists, or neurologists if the damage is particularly severe or complex. Establish admission criteria after determining the severity and degree of the damage. Select the right degree of treatment for the patient's unique medical requirements by deciding whether to admit them to an intensive care unit or a burn unit.

Rehabilitation - Create a systematic strategy for ongoing follow-up treatment and facilitate comprehensive rehabilitation services to help patients who are coping with significant neurological impairments or chronic consequences. This strategy attempts to improve their long-term healing, functional capabilities, and general quality of life.

Psychological Support - Recognize the psychological impact of electrical injuries and provide tailored emotional support and counseling to patients in order to address any particular mental health issues they may be experiencing. This method aims to reduce trauma, anxiety, and suffering while encouraging rehabilitation for those impacted by such occurrences.

Conclusion

In conclusion, treating electrical injuries in the emergency department is a challenging procedure that calls for a thorough comprehension of both the damage and the patient's general condition. The best results require prompt assessment, adequate diagnostics, and specialized treatment strategies. Due to the intricacy of these injuries, a coordinated, multidisciplinary response combining emergency medical personnel, nurses, burn specialists, and even electrical engineers is essential. Monitoring for complications and extensive follow-up treatment are necessary for effective management. By following evidence-based recommendations and exercising caution in the emergency room, healthcare professionals may make a substantial contribution to the recovery and well-being of patients with electrical injuries.

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Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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