Electrical Emergencies

1. Electrical Emergencies Presence Regional EMS July 2013 CE

2. Objectives • Discuss the importance of scene size up, scene safety and rescue. • Describe the mechanism of injury in electrical emergencies. • Demonstrate the assessment and management of a patient exposed to electricity.

3. Electrical Emergencies • High Voltage exposure • Low Voltage exposure • Lightning strikes

4. Scene Safety • Scene Size Up • Remove patient from current • What is your plan?

6. Severity of Injury • Type and amount of current • Path of current • Duration of contact with current

7. Electrical Vocabulary • Voltage • Difference of electrical potential between two points • Different concentrations of electrons • Amperes • Strength of electrical current • Resistance (Ohms) • Opposition to electrical flow

8. Current Flow • Completion of circuit between source and ground

9. Electrical Current • Insulators • Conductors

10. Path of Least Resistance • Follow the electrons • Nervous system • Heart rhythms • Muscle Contractions • Follow the water • All cells are made of water • Blood vessels

11. Path of Greatest Resistance • Skin • Bone

12. Greatest heat occurs at the points of resistance • Entrance and Exit wounds • Dry skin = Greater resistance • Wet Skin = Less resistance

13. Longer the contact, the greater the potential of injury • Increased damage inside body • Smaller the point of contact, the more concentrated the energy, the greater the injury

14. Cardiac Dysrhythmias • Premature ventricular contractions • Ventricular tachycardia • Ventricular fibrillation • Began with a normal healthy heart

16. All electrical emergencies are considered high risk for cardiac arrest !!

17. Neurological Disorders • Depolarization of brain neurons = unconsciousness • “Unable to let go” peripheral hyper-stimulation

18. Tissue Damage • Entrance and exit wounds • Treat as thermal burns • Fractures and dislocations • Muscle damage • Intravascular coagulation

19. Tissue Injury • Electrical burns are always more severe than external signs indicate.

22. Assessment • Scene Safety • Entrance & Exit wounds • Treat any visible injuries • Thermal burns • Remove clothing, jewelry, and leather items • Head to toe exam • Potential fractures • Neurological injuries

23. Assessment • ECG monitoring • Bradycardia, Tachycardia, VF or Asystole • ACLS Protocols • Treat cardiac & respiratory arrest • Aggressive airway, ventilation, and circulatory management.

24. Management • CPR/AED as needed • Treat cardiac rhythms

25. Management (continued) • Manage burn • Splint fractures • Consider Fluid bolus for serious burns --20 ml/kg

26. Lightning Strikes

27. Cardio-respiratory Arrest • DC current acts like defibrillation • Heart resumes beating spontaneously • Respiratory effort delayed much longer than cardiac activity

29. Scenario • Dispatch: • Mid January, 1500 hours for a collapsed 20 year old male.

30. On Arrival • You find 20-year-old Chad lying on the lawn of his house. His friends tell you he standing on an aluminum ladder, taking down the Christmas lights when there was a huge flash of light and he was thrown to the ground. Chad is lying approximately 10 feet from a high power line. The line is not down, but still strung on the poles. There is a metal pole in Chad’s hands.

31. Initial Assessment • Mental Status: Awake, confused and anxious. “What is going on?” • Airway: Open and clear • Breathing: 22 per minute and shallow. No chest movement, only abdominal breathing.

32. Initial Assessment (continued) • Circulation: Skin warm, pink and dry. Hands are burnt into claws around the pole, with open charred wounds on the palms. He has open charred wounds on his feet. • His radial pulse is 60 and weak. • Chief complaint: “I can’t feel anything, what happened?”

33. Focused History • Allergies: None • Medications: None • Past Medical History: None, healthy young man. • Last Meal: 5 or 6 beers in the last 3 hours. • Events: Chad was taking down the lights when the metal pole he was using must have touched the power line to the house. He was thrown approximately 10 feet and landed on his back.

34. Head to Toe Exam • No injury to the head • Neck has posterior tenderness with a step down • NO JVD, No tracheal deviation • Chad is unable to move his arms or legs, he has no sensation from the shoulders down.

35. Head to Toe Exam (continued) • Breath sounds are bilateral but hard to hear. • No rigidity or tenderness to the abdomen • His left leg is shortened and grossly swollen at the mid femur

36. Head to Toe Exam (continued) • His blood sugar is 120 • The cardiac monitor shows PVCs in normal sinus rhythm • Pulse oximetery 90% on room air

37. Head to Toe Exam (continued) • Vital signs: • BP 90/60 • pulse 60 and weak • respirations 22 and shallow

38. What do you do now? • How do you want to manage Chad? • What do you need to do to improve his respirations and circulation?

39. Review Questions • Consider the following questions as a group. • If doing this CE individually, please e-mail your answers to: • Shelley.peelman@presencehealth.org • Use “July 2013 CE” in subject box. • You will receive an e-mail confirmation. Print this confirmation for your records, and document the CE in your PREMSS CE record book.

40. Review Questions (continued) • What body systems are involved in this scenario? • What is the mechanism or mechanisms that caused Chad’s paralysis? • Why does Chad have the vital signs he does? What do these vital signs indicate? • Why does a healthy 20 year-old have an abnormal heart rhythm?

41. Review Questions (continued) • How will you manage Chad’s wounds? • What happened to Chad’s femur? How did that happen? What will you do about it? • Will you be able to tell the extent of Chad’s wounds at the scene? • How will Chad do? Could this be fatal? What is he at risk for? How well will his wounds heal?