A teenaged woman presents at 32weeks gestation, c/o fingertip pain after experiencing a brief electric shock at home. How do you evaluate and care for this patient?
1. Find out what exactly she was shocked by (and for about how long). Most homes and businesses use alternating current but home computers use direct current. AC is thought to be more deadly bc it can induce tetanic muscle contractions and thusly prolongs the duration of contact with the power source.
2. Ask about blunt trauma and LOC; sometimes current can “throw” a person backwards, causing further trauma.
3. Find out if she was perspiring or wet at the time of the shock delivery. Water is a wonderful conductor of electrical current and cause thusly cause more internal injuries than are visible or initially suspected.
4. All pregnancies over 20wks gestation should have cardiotocographic monitoring to evaluate for fetal distress and uterine contractions; let OB/GYN know about the patient.
5. Update her tetanus vaccination.
6. Complete a thorough trauma physicial exam; range and palpate all joints and long-bones.
7. Care for any burns as usual, and consider transfer to burn center, PRN.
8. The need for ecg and labs are guided by your history and exam.
Ref:
Knapp, B, Belsches A. Electrical Injuries Risk Stratification and Treatment. Emergency Medicine. 2012 April; 44 (4): 5-13.
