Electrocution/Lightning Strike

Injury from lightning and electricity occurs due direct injury to the brain, heart, cell membranes and the vasculature and heat injury/burns.

AC Current Shocks

Electrical shock from AC current can result in prolonged electrocution due to muscular tetany and inability to release. Muscular injury, heat injury and potential of precipitation of ventricular fibrillation are all concerns.

Lightning Strikes

Lightning strike results in 30% immediate mortality and 70% of survivors having significant morbidity. The massive energy involved will depolarize the myocardium and may result in VF or asystole. In many cases organized cardiac activity will return, but thoracic muscular dysfunction and depressed respiratory center drive in the brain may result in lack of ventilation and secondary hypoxic cardiac arrest. Additional burn injuries may result as may cerebral hemorrhage, edema and other neuronal injuries.

Notes

• Use standard ACLS protocols paying attention to defibrillation if appropriate and respiratory support
• Aggressive resuscitation, even for prolonged periods is indicated even for victims who appear dead as success is more likely than for other causes of cardiac or respiratory arrest
• Remove hot or smoldering clothes, shoes, belts or items in contact with patient
• Spinal precautions as C-spine or other spinal fracture may be present
• Patients with burns to head or neck should have early advanced airway placement as edema often ensues
• Large amounts of IV fluids may be needed for hypotension due to third spacing
• Be aware that the extent of outward injury may not be predictive of the actual degree of tissue injury

Source: Circulation 2005;112. 2005 AHA Guidelines for CPR and ECC.