The Resus Room Podcast: Exploring Electrical Injuries

Those who know me know how much I appreciate The Resus Room podcast, an extraordinary resource for anyone working or interested in the world of health emergencies. The podcast is in British English (so not always easy for an Italian to follow), but the quality of the content is so high that it is worth the extra effort to overcome the language barrier.

In the latest episode, Simon, Rob, and James tackle a fascinating but often overlooked topic: electrical injuries . A subject that, as they themselves point out, suffers from a lack of clear guidelines in clinical practice.

Why you should listen to this episode

Electrical injuries are more common than you might think and can occur in a variety of settings:

• domestic accidents

• Work accidents

• Use of tasers

• Lightning

The severity can range from simple shocks to life-threatening events such as cardiac arrest. But the question that often arises is: who actually needs to go to the hospital after an electric shock?

Mechanisms of damage of electricity on the human body

The podcast explores the three main mechanisms by which electricity can damage our bodies:

1. Direct effects on electrical conduction of tissues : can lead to arrhythmias or cardiac arrest

2. Thermal effects : Electricity generates heat, causing burns that are often deep and not immediately visible.

3. Mechanical effects : violent muscle contractions can cause fractures or trauma due to falls

   
   

Low and high voltage: crucial differences

A key distinction discussed in the podcast concerns tension:

• Low voltage (<1000 volts): includes common household shocks and some industrial accidents

• High voltage (>1,000 volts): Includes power lines and lightning, with the potential for devastating internal burns

Analyzing the difference between alternating current (AC) and direct current (DC) is also interesting. The former tends to cause tetanic contractions that "glue" the victim to the source, while the latter causes a violent contraction that often pushes the person away from the electrical source (remember the scene in Jurassic Park with the T-Rex cage ?)

Systematic clinical approach to electrical injuries

The podcast hosts suggest a clear and structured ABCDE approach:

• A (Airway) : Assessment of the airway

• B (Respiration) : Monitoring of respiration

• C (Circulation) : ECG monitoring and arrhythmia screening

• D (Handicap) : Neurological assessment

• E (Exposure) : Location of current entry and exit points, paying attention to burns

PMID: 37526697

Special cases: Tasers and lightning

The episode also addresses unique situations such as Taser injuries (usually less serious) and lightning strikes, which can cause a unique injury pattern with superficial burns but also deep internal injuries.

When is hospitalization necessary?

One of the most practical aspects discussed concerns the criteria for deciding who needs hospital observation. Generally, patients with:

• ECG changes

• Chest pain or palpitations

• Loss of consciousness

• Obvious burns

must be kept under observation for at least 24 hours.

Overview: EMSy and Prehospital Management

In addition to the information provided by The Resus Room podcast , I tried asking EMSy, our chatbot specializing in prehospital emergency medicine, how to manage electrical injuries. EMSy offers a few additional elements that are particularly useful for healthcare personnel working in the prehospital setting:

• Current specific pathways : Detailed classification of pathways (hand-hand, hand-foot, head-foot) with associated clinical implications

• Lightning Triage : In patients struck by lightning, prioritize those who appear to have no vital signs

• Extended arrhythmia monitoring : The risk of arrhythmia may persist for up to 72 hours

• Centralization criteria : Specific indications on the time of transfer to specialized centers

• Fluid therapy : Standard formulas for burns may underestimate the needs in cases of electrical injuries

I invite you to experience it firsthand by asking EMSy about electrical injuries: you may discover additional details relevant to your clinical practice that were not covered in this article.

Conclusion

If you work in healthcare or are simply curious to learn more about this topic, I highly recommend listening to the full episode of The Resus Room . The hosts did an excellent job of distilling a complex topic into accessible and, most importantly, clinically relevant content.

You can find “The Resus Room” podcast on all major streaming platforms or directly on their website .

Have you ever treated a patient with electrical injuries? What were your experiences? Bibliography

• Seyfrydova M, Rokyta R, Rajdl D, Huml M. “Arrhythmias and laboratory abnormalities after electrical injury: a single-center retrospective study of 333 cases.” Clinical Research in Cardiology , December 2023, Volume 112, Issue 12, Pages 1835-1847. DOI: 10.1007/s00392-023-02274-5

• Ohlén D, Hedberg M, Martinsson P, von Oelreich E, Djärv T, Jonsson Fagerlund M. “Characteristics and outcomes of traumatic cardiac arrest in a level 1 trauma center over 10 years in Sweden.” Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , October 2022, Volume 30, Issue 1, Article 54. DOI: 10.1186/s13049-022-01039-9