You are working as a Paramedic, Technician crew on an EA when you are called to a reported electrocution incident on a building site. There is a male who is currently unconscious following what his colleagues describe as an electrocution incident. You start traveling to the scene on blue lights and sirens.
On arrival, you and your colleague gather your equipment and are shown into a large facility. You see the patient next to a large transformer device. His colleagues explain he is one of the electricians on-site working on the device, heard a big bang, and the next thing he was unconscious on the floor.
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From where you are, you see that he is unconscious, rather pale in pallor, and you can hear him snoring very loudly. What are your first actions
Your colleague starts to make their way to the patient but you stop them as you have concerns over the safety of the scene. You query the site management, and the head electrician confirms that the unit has been isolated and it is safe to approach.
You and your colleague approach the patient. They are a male in their 40’s, you note a large burn on their right hand, and an exit burn on their left knee. The patient is supine on the floor with no obvious external haemorrhage concerns. Your colleague starts to manage observations. Electrocution incidents can cause high risk for arrhythmias to develop in the patient. With this info, what is recommended to be placed early on an electrocution patient
Defibrillator pads are attached due to the potential cardiac arrhythmias which can be caused by electrocution injuries. You review the primary survey, they haven’t been thrown from the device and you are happy with C-spine, the patient is still snoring, has a slight tachypnoeic rate of ventilations, and a pale pallor to their skin. What is your first management
You quickly inspect the airway and note some secretions which you use suction to get rid of. You notice the tongue is falling back and may be the source of the patients’ snoring. You place an OPA which the patient takes. This stops the snoring sound and you feel the airway is now patent and managed. You assess breathing and note a rate of 24. You conduct a FLAPS TWELVE assessment and note nothing of major concern. Your colleague advises you that oxygen saturations area at 92%. His colleagues advise that he has no past medical history, but is a moderate smoker. Is Oxygen therapy safe to be used in this scenario
As the scene has been made safe and there is no risk of electrical sparks, you administer O2 to the patient and note an immediate rise in saturation to 98%. You quickly take radial pulses but note they are weak and slow. The defibrillator monitor shows a narrow complex bradycardia rhythm at a rate of 30, with blood pressure returning at 96/55. What medication can you consider for the cardiac arrhythmia
What is the dosage of Atropine in an adult patient with no contra-indications
You gain IV access and administer the atropine, continuing with your primary survey. The patient remains in a GCS 3 state, pupils are PERRL, the temperature has come back as 36.8⁰C, blood sugars 6.4. You examine the burn on his hand and knee and note significant deep tissue damage and charring. There is some clothing material around the knee that is smouldering. Should you try and remove the clothing if it isn’t stuck to the skin
Your colleague goes to get the stretcher from the EA after helping you remove the smouldering clothing. They will take some time due to the distance needed to cover within the facility. You have also requested further backup support to assist with the extrication and transfer to the hospital, due to the poor condition of the patient. Should you try and cool the burns
You ask the workmen if they are able to source tepid clean water from anywhere and they advise they have numerous crates of bottled water in a nearby store. They bring the water and you advise them to start gently pouring it onto the burned areas. How long should this cooling process be done where possible
As they continue to cool the burns, you continue with another primary survey. Still no Cat haem, Airway is patent and managed with the OPA, Breathing rate has eased to 18 resps per minute and O2 levels are maintaining at 98%. Circulation is doing better with the heart rate now around 65 BPM and blood pressure of 109/68. The patient’s GCS is still 3 and obs are the same. Is a 12 lead ECG recommended in electrical injury patients
Your colleague returns with a stretcher and extrication equipment. You scoop the patient onto the stretcher and start taking him to the EA. The workmen continue to administer cooling with the bottled water whilst on the move. You give the hospital a pre-alert for the patient and are questioned as to how many volts were involved. The workmen explain it is greater than 480 volts. What category of voltage does this come under