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Electric shock may produce loss of consciousness With recovery there may be muscular pain, fatigue, headache, and nervous irritability The physical signs vary according to the action of the current Ventricular fibrillation or respiratory failure or both can occur; the patient may be unconscious, pulseless, hypotensive, cold and cyanotic, and without respirations



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The victim must be separated from the electric current prior to initiation of CPR or other treatment; the rescuer must be protected Turn off the power, sever the wire with a dry wooden-handled ax, make a proper ground to divert the current, or separate the victim using nonconductive implements such as dry clothing





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Lightning or unstable electric shock victims should be hospitalized when revived and observed for shock, arrhythmia, thrombosis, infarction, sudden cardiac dilation, hemorrhage, and myoglobinuria A urinalysis, urine myoglobin, serum creatine kinase and creatine kinase-MB, and an ECG should be obtained immediately Victims should also be evaluated for hidden injury (eg, ophthalmic, otologic, muscular, compartment syndromes), organ injury (myocardium, liver, kidney, pancreas), blunt trauma, dehydration, skin burns, hypertension, posttraumatic stress, acid-base disturbances, and neurologic damage Indications for hospitalization include significant arrhythmia or ECG changes, large burn, loss of consciousness, pulmonary or cardiac symptoms, or evidence of significant deep tissue or organ damage Extra caution is indicated when the electroshock current has followed a transthoracic route (hand to hand or hand to foot) and in patients with a cardiac history To counteract fluid losses and myoglobinuria due to electric shock (not lightning) burns, aggressive hydration with Ringer s lactate should seek to achieve a urinary output of 50 100 mL/h

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Complications may occur in almost any part of the body but most commonly include sepsis; gangrene requiring limb amputation; or neurologic, cardiac, cognitive, or psychiatric dysfunction Psychiatric support may be necessary following lightning or severe electroshock exposures

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Edlich RF et al Modern concepts of treatment and prevention of lightning injuries J Long Term Eff Medical Implants 2005; 15(2):185 96 [PMID: 15777170] O Keefe Gatewood M et al Lightning injuries Emerg Med Clin North Am 2004 May;22(2):369 403 [PMID: 15163573] Selvaggi G et al Rehabilitation of burn injured patients following lightning and electrical trauma NeuroRehabilitation 2005;20(1):35 42 [PMID: 15798354] Spies C et al Narrative review: Electrocution and life-threatening electrical injuries Ann Intern Med 2006 Oct 3;145(7): 531 7 [PMID: 17015871]

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occupationally exposed workers over age 18 as 1 mSv (01 rem)* per week for the whole body (but not to exceed 50 mSv per year) and 15 mSv per week for the hands (For purposes of comparison, routine chest radiographs deliver from 1 mSv to 2 mSv) The US Food and Drug Administration has recommended 1 Gy as a threshold for skin-absorbed dose from medical fluoroscopy Death after whole body acute lethal radiation exposure is usually due to hematopoietic failure, gastrointestinal mucosal damage, central nervous system damage, widespread vascular injury, or secondary infection The acute radiation syndrome may be dominated by central nervous system, gastrointestinal, or hematologic manifestations depending on dose and survival Fatigue, weakness, and anorexia can occur following exposures exceeding 50 cGy Hematopoietic effects consisting of anemia, platelet loss, and bone marrow suppression can occur 1 3 weeks after exposures exceeding 100 cGy Exposure to 400 600 cGy may be fatal within 60 days; death is usually due to hemorrhage, anemia, and infection secondary to hematopoietic injury Whole body exposure levels of 1000 3000 cGy destroy gastrointestinal mucosa; this leads to toxemia and death within 2 weeks Total body doses above 3000 cGy cause widespread vascular damage, cerebral anoxia, hypotensive shock, and death within 48 hours

Irradiation may cause erythema, epilation, destruction of fingernails, or epidermolysis Ionizing radiation burns appear similar to thermal burns but usually have a slower onset and course

1 Hematopoietic tissues Injury to the bone marrow may cause diminished production of blood elements Lymphocytes are most sensitive, polymorphonuclear leukocytes next most sensitive, and erythrocytes least sensitive Damage to the blood-forming organs may vary from transient depression of one or more blood elements to complete destruction 2 Cardiovascular system Pericarditis with effusion or constrictive pericarditis may occur after a period of months or even years Myocarditis is less common Smaller vessels (the capillaries and arterioles) are more readily damaged than larger blood vessels

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