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Learning Station 3 Environmental Emergency 8 Construction Worker Found Down

1999 American Heart Association

We acknowledge the outstanding contribution of B. Keith Chapman, EMT-P, of Temple Terrace, FL, who provided initial drafts of all the teaching support materials for this section.

Case 1

41-year-old construction worker found down in electrical room Supine on the floor not moving You see Large laceration on workers arm Large hematoma on workers head High-voltage wires in newly cut access panel Contents of tool box scattered all over the room

You make the call!

First Priority

Suspect electrocution! Turn off or remove the source of energy

Assess and Treat

Use the Five Quadrads Approach Arrest Primary ABCD Survey Secondary ABCD Survey Periarrest OxygenIVmonitorfluids TempBPHRResp Tanktankpumprate

First and Second Quadrads Reveal

High-voltage cables to room: turned off Scene now safe examine the victim Primary ABCD Survey Airway: open Breathing: respirations absent Circulation: strong pulse present Defibrillation: not needed with pulse Secondary ABCD Survey Airway/breathing: needs intubation Circulation: start IV, check rhythm Differential diagnosis: what has happened?

Continue to Assess and Treat Based on Five Quadrads

Second Quadrad: advanced ABCD needs intubation Secure artificial airway early Extensive soft tissue swelling may occur rapidly, making tracheal intubation difficult Swelling is a particular risk with electrical burns to the face, mouth, or anterior neck Third Quadrad: O2IVmonitorfluids Treat arrhythmias according to the ACLS guidelines

Assess and Treat

Fourth Quadrad: temperatureblood pressureheart raterespiratory rate Temp = 99.8F Blood pressure = 138/90 mm Hg Heart rate = 118 bpm Respiratory rate = 0
Why is the patient not breathing?

Respiratory Arrest due to Electrocution

Electric current passing through the brain inhibits the respiratory center Muscles of the diaphragm and chest wall go into tetanic contraction Respiratory muscles experience prolonged paralysis Correct the hypoxia!

Several Factors Determine Injury Severity

Voltage of source Resistance to current flow Alternating vs direct current Duration of contact Current pathway: which organs in path


Alternating Current

50 to 60 cycles per second (household) Skeletal muscle spasm can keep victim from releasing electrical source Can lead to prolonged exposure Increased chances of electrical stimulation during cardiac recovery period causing VF (R-on-T phenomenon)

Resistance to Current Flow

Skin resistance: most important Resistance reduced by moisture Low resistance more current flow Wet skin surface converts ordinary low-voltage injury into a life-threatening shock

Current Pathway

Transthoracic current flow: arm-to-arm; arm-to-foot; foot-to-foot = straddle; likely to be fatal Vertical pathway: often causes myocardial injury due to direct effects of current and coronary spasm


Electrocution: the Bottom Line

Cardiopulmonary arrest is the primary cause of immediate death VF or asystole may occur immediately Other arrhythmias, such as VT, may occur at first, then change to VF Arrests and arrhythmias can result from exposure to either low- or high-voltage current Always think of cardiac arrest due to electrocution as cardiac arrest associated with trauma

Hospital Treatment

Patient arrives intubated, with c-spine immobilization Attending MD evaluates Rule out c-spine injury Key: Consult early with MD expert in treating electrical injuries Some patients require extensive surgical intervention

Watch for Rescuer Safety! Use the Five Quadrads Approach Always treat as trauma event Treat hypoxia early, long, and aggressively Transport to appropriate hospital with resources to treat this emergency