7/27/2019 LS3ENV8

1/17

1

Learning Station 3

Environmental Emergency 8

Construction WorkerFound Down

1999 American Heart Association

7/27/2019 LS3ENV8

2/17

2

Acknowledgments

We acknowledge the outstanding contribution

of B. Keith Chapman, EMT-P, of Temple

Terrace, FL, who provided initial drafts of allthe teaching support materials for this section.

7/27/2019 LS3ENV8

3/17

3

Case 1

41-year-old construction worker found down in

electrical room

Supine on the floornot 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!

7/27/2019 LS3ENV8

4/17

4

First Priority

SCENE SAFETY!Suspect electrocution!

Turn off or remove

the source of energy

7/27/2019 LS3ENV8

5/17

5

Assess and Treat

Use the Five Quadrads Approach

Arrest

Primary ABCD Survey

Secondary ABCD Survey

Periarrest

OxygenIVmonitorfluidsTempBPHRResp

Tanktankpumprate

7/27/2019 LS3ENV8

6/17

6

First and Second QuadradsReveal

High-voltage cables to room: turned off Scene now safeexamine 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?

7/27/2019 LS3ENV8

7/177

Continue to Assess and TreatBased on Five Quadrads

Second Quadrad: advanced ABCD needsintubation

Secure artificial airway early

Extensive soft tissue swelling may occurrapidly, making tracheal intubationdifficult

Swelling is a particular risk with electrical

burns to the face, mouth, or anterior neck Third Quadrad: O2IVmonitorfluids

Treat arrhythmias according to the ACLSguidelines

7/27/2019 LS3ENV8

8/17

8

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?

7/27/2019 LS3ENV8

9/17

9

Respiratory Arrest due toElectrocution

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!

7/27/2019 LS3ENV8

10/17

10

Several Factors DetermineInjury Severity

Voltage of source

Resistance to current flow

Alternating vs direct current

Duration of contact

Current pathway:which organs in path

7/27/2019 LS3ENV8

11/17

11

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)

7/27/2019 LS3ENV8

12/17

12

Resistance to Current Flow

Skin resistance: most important

Resistance reduced by

moisture Low resistance more

current flow

Wet skin surface convertsordinary low-voltage injuryinto a life-threatening shock

7/27/2019 LS3ENV8

13/17

13

Current Pathway

Transthoracic cur rent f low: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

7/27/2019 LS3ENV8

14/17

14

Electrocution: the Bottom Line

Cardiopulmonary arrest is the primary cause ofimmediate 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

7/27/2019 LS3ENV8

15/17

15

Hospital Treatment

Patient arrives intubated, with c-spineimmobilization

Attending MD evaluates Rule out c-spine injury

Key: Consult early with MD expert in

treating electrical injuries Some patients require extensive surgical

intervention

7/27/2019 LS3ENV8

16/17

16

Conclusion

Watch for Rescuer Safety!

Use the Five Quadrads Approach

Always treat as trauma event

Treat hypoxia early, long, and aggressively

Transport to appropriate hospital withresources to treat this emergency

7/27/2019 LS3ENV8

17/17

17

Questions?