Electric shock

Assessment-History

Exposure to electricity or lightning Tingling sensation Loss of consciousness Muscle pain Fatigue Headache Nervous irritability

Diagnostic Test Results-Laboratory

Urinalysis shows evidence of myoglobin. Arterial blood gas (ABG) analysis may reveal acid-base imbalances. Cardiac isoenzyme levels may indicate cardiac tissue damage.

Nursing Considerations-Monitoring

Vital signs Cardiac rhythm (continuously) Hourly urine output Intake Skin integrity Pain level and relief Oxygen saturation level Electrolyte levels Acid-base balance via ABG analysis Neurologic status Sensorimotor deficits Peripheral neurovascular status

Nursing Considerations-Associated Nursing Procedures

12-lead electrocardiogram (ECG) Arterial puncture for blood gas analysis Blood pressure assessment Burn care Burn dressing change Calculating and setting an IV drip rate Cardiac monitoring Cardiopulmonary resuscitation (CPR), one-person Cardiopulmonary resuscitation (CPR), two-person Code management Defibrillation IV bag preparation IV bolus injection IV catheter insertion IV pump use Indwelling urinary catheter (Foley) care and management Indwelling urinary catheter (Foley) insertion, female Indwelling urinary catheter (Foley) insertion, male Intake and output assessment Intramuscular injection Neurologic assessment Oral drug administration Oxygen administration Pain management Pulse oximetry Pulse assessment Respiration assessment Topical skin drug application Urine specimen collection, random Venipuncture

Overview-Causes

Accidental contact with an exposed part of an electrical appliance or wiring Flash of electric arcs from high-voltage power lines or machines Lightning

Nursing Considerations-Nursing Diagnoses

Acute pain Anxiety Decreased cardiac output Impaired spontaneous ventilation Risk for decreased cardiac perfusion Risk for impaired skin integrity Risk for injury Risk for posttrauma syndrome

Diagnostic Test Results-Imaging

Computed tomography or magnetic resonance imaging may rule out intracranial bleeding or contusion of the brain if the patient is unresponsive or unconscious. X-rays reveal internal damage, such as fractures and dislocations.

Assessment-Physical Findings

Determined by voltage exposure Burns; charred skin Local tissue coagulation Entrance and exit injuries Cyanosis Apnea Markedly decreased blood pressure Cold skin Unconsciousness Arrhythmias Ruptured eardrum (lightning) Numbness or tingling or sensorimotor deficits Fixed, dilated, or asymmetric pupils

Treatment-Medications

Diuretic, such as furosemide or mannitol, to maintain urinary output Analgesic, such as morphine for severe pain or oral analgesic (such as acetaminophen with codeine, acetaminophen with oxycodone, or acetaminophen with hydrocodone) for moderate pain Topical burn therapy, such as silver sulfadiazine (Silvadene) Oxygen therapy Urinary alkalinizers to prevent myoglobin precipitation into renal tubules Histamine-2 receptor antagonist, such as ranitidine hydrochloride (Zantac), for stress ulcer prophylaxis Tetanus prophylaxis Vigorous fluid replacement, such as with an I.V. isotonic balanced saline solution

Overview

Electric current passing through body Physical damage depending on the intensity of the current, resistance of the tissues it passes through, type of current, and frequency and duration of current flow Classified as lightning, low-voltage (less than 600 V), and high-voltage (greater than 600 V) Potential for significant injury with little damage to the overlying skin (see Four classes of electrical injury)

Overview-Incidence

Electric shock accounts for approximately 1,000 deaths annually. Electric shock occurs more commonly in men ages 20 to 40. Most electrical injuries are related to low-voltage electricity. Workplace electrocutions account for 5% of all worker deaths. The majority of electrical shock injuries in adults occur in males. Death from lightning injuries occurs within 1 hour of injury in two-thirds of cases, usually due to a fatal arrhythmia or respiratory failure.

Overview-Pathophysiology

Electrical energy results in altered cell membrane resting potential, causing depolarization in muscles and nerves. Electric shock alters normal electrical activity of the heart and brain. Electric shock resulting from a high-frequency current generates more heat in tissues than a low-frequency current, resulting in burns and local tissue coagulation and necrosis. Muscle tetany is elicited. Tissue destruction and coagulative necrosis occurs.

Diagnostic Test Results-Other

Electrocardiogram (ECG) reveals cardiac arrhythmias.

Treatment-Activity

Initially, bedrest Based on outcome of interventions

Treatment-Diet

No restrictions if swallowing ability intact

Patient Teaching-Discharge Planning

Refer the patient to rehabilitation, if appropriate. Refer the patient to local agencies for available resources and support services.

Nursing Considerations-Nursing Interventions

Separate the victim from the current source. Provide emergency treatment, including assessment of airway, breathing, and circulation. Begin cardiopulmonary resuscitation, as indicated. Give rapid I.V. fluid infusion via two large-bore I.V. catheters. Obtain a 12-lead ECG and institute continuous cardiac monitoring. Assess hemodynamic parameters and report any significant trends. Give prescribed drugs via I.V. or oral route as appropriate. Assess the patient's pain level using a rating scale; administer analgesics, as prescribed, and evaluate for effectiveness of therapy. Obtain specimens for laboratory testing, including serum electrolyte, blood urea nitrogen, creatinine, and urine myoglobin levels. Insert an indwelling urinary catheter if indicated. Assess urinary output hourly. Administer oxygen as ordered based on pulse oximetry levels and status. Perform skin care and burn site care as appropriate

Treatment-General

Separation of victim from current source Stabilization of cervical spine Emergency measures, such as airway management and cardiac monitoring Treatment of acid-base imbalance

Overview-Complications

Sepsis Complex regional pain syndrome Neurologic dysfunction Cardiac dysfunction Psychiatric dysfunction Renal failure Electrolyte abnormalities Peripheral nerve injuries Vascular disruption Thrombi Death

Patient Teaching-General

information about the injury, diagnosis, and treatment wound care, if indicated, such as dressing changes, topical applications, and types of dressings pain relief measures, including the use of analgesics prescribed medication therapy, including drugs, dosages, rationales for use, and frequency and duration of administration signs and symptoms of complications, including the need to notify a health care provider if any occur ways to avoid electrical hazards at home and at work (see Preventing electric shock) importance of adhering to follow-up.

Nursing Considerations-Expected Outcomes

report pain relief with analgesic or other measures express feelings of decreased anxiety maintain cardiac output regain skin integrity maintain adequate ventilation either spontaneously or with assisted ventilation exhibit signs of adequate cardiopulmonary perfusion exhibit intact skin with signs of healing verbalize methods to prevent future injury from electric shock express feelings and fears about the traumatic event.