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Electrical Emergencies. Presence Regional EMS July 2013 CE. 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.

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Electrical emergencies

Electrical Emergencies

Presence Regional EMS

July 2013 CE


Objectives
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.


Electrical emergencies1
Electrical Emergencies

  • High Voltage exposure

  • Low Voltage exposure

  • Lightning strikes


Scene safety
Scene Safety

  • Scene Size Up

  • Remove patient from current

  • What is your plan?


Severity of injury
Severity of Injury

  • Type and amount of current

  • Path of current

  • Duration of contact with current


Electrical vocabulary
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


Current flow
Current Flow

  • Completion of circuit between source and ground


Electrical current
Electrical Current

  • Insulators

  • Conductors


Path of least resistance
Path of Least Resistance

  • Follow the electrons

    • Nervous system

    • Heart rhythms

    • Muscle Contractions

  • Follow the water

    • All cells are made of water

    • Blood vessels





Cardiac dysrhythmias
Cardiac Dysrhythmias

  • Premature ventricular contractions

  • Ventricular tachycardia

  • Ventricular fibrillation

  • Began with a normal healthy heart



Neurological disorders
Neurological Disorders cardiac arrest !!

  • Depolarization of brain neurons = unconsciousness

  • “Unable to let go” peripheral hyper-stimulation


Tissue damage
Tissue Damage cardiac arrest !!

  • Entrance and exit wounds

  • Treat as thermal burns

  • Fractures and dislocations

  • Muscle damage

  • Intravascular coagulation


Tissue injury
Tissue Injury cardiac arrest !!

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


Assessment
Assessment cardiac arrest !!

  • 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


Assessment1
Assessment cardiac arrest !!

  • ECG monitoring

    • Bradycardia, Tachycardia, VF or Asystole

      • ACLS Protocols

    • Treat cardiac & respiratory arrest

    • Aggressive airway, ventilation, and circulatory management.


Management
Management cardiac arrest !!

  • CPR/AED as needed

  • Treat cardiac rhythms


Management continued
Management cardiac arrest !!(continued)

  • Manage burn

  • Splint fractures

  • Consider Fluid bolus for serious burns --20 ml/kg


Lightning strikes
Lightning Strikes cardiac arrest !!


Cardio respiratory arrest
Cardio-respiratory Arrest cardiac arrest !!

  • DC current acts like defibrillation

  • Heart resumes beating spontaneously

  • Respiratory effort delayed much longer than cardiac activity


Scenario
Scenario cardiac arrest !!

  • Dispatch:

    • Mid January, 1500 hours for a collapsed 20 year old male.


On arrival
On Arrival cardiac arrest !!

  • 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.


Initial assessment
Initial Assessment cardiac arrest !!

  • 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.


Initial assessment continued
Initial Assessment cardiac arrest !!(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?”


Focused history
Focused History cardiac arrest !!

  • 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.


Head to toe exam
Head to Toe Exam cardiac arrest !!

  • 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.


Head to toe exam continued
Head to Toe Exam cardiac arrest !!(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


Head to toe exam continued1
Head to Toe Exam cardiac arrest !!(continued)

  • His blood sugar is 120

  • The cardiac monitor shows PVCs in normal sinus rhythm

  • Pulse oximetery 90% on room air


Head to toe exam continued2
Head to Toe Exam cardiac arrest !!(continued)

  • Vital signs:

    • BP 90/60

    • pulse 60 and weak

    • respirations 22 and shallow


What do you do now
What do you do now? cardiac arrest !!

  • How do you want to manage Chad?

  • What do you need to do to improve his respirations and circulation?


Review questions
Review Questions cardiac arrest !!

  • Consider the following questions as a group.

  • If doing this CE individually, please e-mail your answers to:

  • [email protected]

  • 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.


Review questions continued
Review Questions cardiac arrest !!(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?


Review questions continued1
Review Questions cardiac arrest !!(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?


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