ENVIRONMENTAL
ELECTRICAL INJURY
PromptFactors determining severity of electrical injury
ResponseType of current
AC higher risk of VF
DC + high voltage AC - throw person away from source, risk of Asystole
Voltage level
High voltage is >1000 V (?600V) - high risk injury
Current (Answers vary WILDLY here - first 3 from ACI website, last from prior Q’s)
1-3 mA = Pain
10 mA = Muscle contractions
100 mA = VF, Respiratory arrest, severe burns
(2-10 A = Asystole?)
Duration of contact (Longer is worse)
AC precipitates tetanic muscle contractions (can grab on to wire) >> prolonged contact
Skin - wet skin is better conductor so increased likelihood of injury
Pathway of current
Pathway determines type and severity of injury
Vertical pathway most dangerous as all organs in line of injury
Horizontal pathway spares brain but can still be fatal due to heart, resp muscle and spinal cord involvement.
Non-electrical factors
Thrown - associated with trauma
Arc burns or flash/flame injury
Non mobile patient
AC higher risk of VF
DC + high voltage AC - throw person away from source, risk of Asystole
Voltage level
High voltage is >1000 V (?600V) - high risk injury
Current (Answers vary WILDLY here - first 3 from ACI website, last from prior Q’s)
1-3 mA = Pain
10 mA = Muscle contractions
100 mA = VF, Respiratory arrest, severe burns
(2-10 A = Asystole?)
Duration of contact (Longer is worse)
AC precipitates tetanic muscle contractions (can grab on to wire) >> prolonged contact
Skin - wet skin is better conductor so increased likelihood of injury
Pathway of current
Pathway determines type and severity of injury
Vertical pathway most dangerous as all organs in line of injury
Horizontal pathway spares brain but can still be fatal due to heart, resp muscle and spinal cord involvement.
Non-electrical factors
Thrown - associated with trauma
Arc burns or flash/flame injury
Non mobile patient
PromptTypes of injuries sustained with electrical injuries
ResponseThermal burns
- Skin - varying thickness
- Eyes
- Compartment syndrome
- Blunt trauma to head/spine/chest/abdo from blast.
- Contusions including cardiac contusion
- TM rupture
- Arrhythmias including malignant (VF/Asystole). Suspect if high voltage injury (Substation), evidence of trans-thoracic current
- Direct myocardial necrosis in high voltage or AC currents
- Altered LOC, seizures, coma
- Hypoxic brain injury from cardiac arrest
- Continuous tetanic contractions
- Nervous system - peripheral nerve injury/parasthesia/paralysis - from current in limbs.
- Spinal injury (Trauma vs muscle spasm)
- Cutaneous burns and vascular injuries - Current through limbs, vasospasm, thrombosis and ischaemia. Direct heating/burn of tissue
- Rhabdo/AKI
- Compartment syndrome
- Avulsion fractures
PromptInitial management priorities at scene (retrieval question)
ResponseSafe approache/scene safety - Paramedic, fire (responder safety directed by wider team, high risk of provider injury so must not approach until all clear given)
Trauma assessment approach with meaningful interventions (Risk of trauma, avoid delays)
Humanitarian - analgesia/anaesthesia (Expect severe pain
Plan destination - trauma/burns centre - avoid secondary transfer
Fluid management, temperature management (hypothermia from burns, exposed outdoors patient)
Trauma assessment approach with meaningful interventions (Risk of trauma, avoid delays)
Humanitarian - analgesia/anaesthesia (Expect severe pain
Plan destination - trauma/burns centre - avoid secondary transfer
Fluid management, temperature management (hypothermia from burns, exposed outdoors patient)
PromptIndications for telemetry in electouction
ResponseHigh voltage injury >1000 v
Loss of consciousness
Seizures
ECG changes or documented arrhythmias
Previous cardiac diseas (especially arrhythmias)
burns
Loss of consciousness
Seizures
ECG changes or documented arrhythmias
Previous cardiac diseas (especially arrhythmias)
burns
PromptParklands formula in electrical burns
ResponseNope. not validated. Cos you’re cooked from the inside out not the outside in. no %BSA