Electrical Injury

Shocked

Step 1: View clinicals

A 35-year-old construction worker is brought in around 20 minutes after he received an electrical shock from a defective power cord (110 V, 60 Hz, alternating current). He was thrown from a ladder and landed on his back on a concrete floor six feet below. At that time, his co-workers found him to be unconscious and not breathing. They immediately initiated CPR and called in emergency services. The paramedics arrived 10 minutes later and found him to be in cardiopulmonary arrest with a ventricular fibrillation ECG pattern. The patient was defibrillated consecutively as 200, 300 and 360 Joules, and returned to sinus rhythm after the final shock. The patient was defibrillated consecutively as 200, 300 and 360 Joules, and returned to sinus rhythm after the final shock. Subsequently, he was intubated, a cervical collar was placed, and he was immobilized on a spinal board and rushed to the hospital.


Step 2: Order all relevant investigations

ECG

The ECG is in sinus rhythm with a rate of 100 bpm. There are ST elevations >2mm in the leads V5 and V6.

Bedside Echocardiogram

Echocardiography demonstrates segmental wall motion abnormalities corresponding to the cardiac apex.

Urinalysis + CPK

Urinalysis: dipstick positive for blood; no erythrocytes on microscopy Serum creatine phosphokinase (CPK): 40,900 IU/l (normal: 5-100)

CT Brain

CT imaging of the brain shows no abnormalities.


Step 3: Select appropriate management

ICU Admission
IV Fluids
IV Antibiotics
Thrombolytics


Score: ★★☆