Electrocution

[RocketMedic]

So here's a call:

20 y/o male, electrocuted by "270 volts" x 45-60 seconds, then fell 9 feet backwards to concrete. Entry wound to left hand, exit wound to left-center chest (right around V2/V3ish). Patient was in ventricular fibrillation on initial encounter, defibrillated with 200J biphasic to asystole, developed a few agonal low-voltage ventricular complexes but never established a rhythm or achieved ROSC. Treatment was defib, CPR, 7 1mg epi, 75mEq bicarb, 1500mL fluid.

I was wondering what y'all think of potentially pacing this? I reckon his heart was severely damaged by the electrocution, but maybe pacing could have worked?

 

[StCEMT]

I dont know anything about it, but wasn' that practice for certain arrests many years ago?

 

[NPO]

I once asked this question (although about general cardiac arrest), and got very little information. However I once did read that pacing in cardiac arrest in one trial produced no positive outcomes. I really don't remember the specifics of that trial unfortunately.

I don't think it would have been successful in this patient unfortunately.

 

[VFlutter]

Not doubting they were in asystole but many times these patient's are actually in very fine VF. Only other intervention I can think of would be Calcium. I don't think it's unreasonable to attempt pacing.

 

[Carlos Danger]

I'm old enough that we used to pace asystole somewhat routinely, generally in younger, healthier patients with a presumed short down time. These days I doubt it would have even crossed my mind.

Would have been interesting to see if it worked.

 

[johnrsemt]

Not going to hurt the patient to try to pace them.

Worked with an ED doc that would ask us during arrests if anyone had any ideas; some of the older nurses would come up with some wild ideas. Doc would try them. and explain why they didn't work and why they didn't do them anymore. Really aggravating when a couple of them worked

 

[VFlutter]

Just a note that ACLS was designed to address the most common cause of Sudden Cardiac Death which is ACS. In my opinion if the cause of the arrest is something uncommon then there is nothing wrong with attempting interventions "outside the box", within reason.

 

[ParamagicFF]

Just a note that ACLS was designed to address the most common cause of Sudden Cardiac Death which is ACS. In my opinion if the cause of the arrest is something uncommon then there is nothing wrong with attempting interventions "outside the box", within reason.

I can't recall the exact wording, but I seem to remember both ACLS and PALS having language in them that emphasizes this. Had a discussion with some physicians recently about overdoses/poisonings that result in arrest, and some of the unusual treatments available.

 

[VFlutter]

I can't recall the exact wording, but I seem to remember both ACLS and PALS having language in them that emphasizes this. Had a discussion with some physicians recently about overdoses/poisonings that result in arrest, and some of the unusual treatments available.

They added "Consider H's and T's" to address this but do not really emphasize it enough IMO.

 

[Aprz]

They added "Consider H's and T's" to address this but do not really emphasize it enough IMO.

I feel we totally fail on H and Ts. We say it "Comsider H and T?!" outloud as if we are checking a box, but don't actually go down the list. I would love to see last ditch efforts like sequential shock and pace before determining death.