After the first-aid treatment of electric shock

First, from the power supply
The first step in first aid from the power supply for the patients, the best way to power electric gates opened immediately, cutting off power supply. However, electrical equipment exposed to some of the patients were given electric shocks, cut off the power supply can be used in drying wood insulation patients away from the equipment, the rescue can be contacted, because the device may have a residual power remained with the the nature of a huge capacitor. If the power switch too far away or can not find a power switch between the rush, then the application of dry wood, bamboo, pole, rubber, and plastic products, such as non-conductive materials of patients with electrical wires or separate, or long-handled wooden knife and ax cut off the live wire. Split live still in a state of electrical appliances, non-contact. Do not save people who push and pull hand directly, contact or contact with metal utensils in order to maintain its own security.

Second, the immediate implementation of the heart, lung recovery
Patients out of power after the cardiopulmonary patients should immediately check the situation. Patients are often unconscious, stop breathing or irregular cardiac arrest or weakened. Had ceased to breathe, the rescue should be the implementation of continuous artificial respiration immediately. Although there is no breathing, such as patients, but heart is still the law, then most of the good prognosis. The patient began to have some restoration of the phenomenon, the artificial respiration to continue to extend necessary to return to normal until the automatic breathing. The death of the patient appears to have looked, most of them due to respiratory paralysis, artificial respiration sustained, there will be some people can be saved. Some people advocate artificial respiration should be continued for at least 4h or even 6 ~ 8h. Artificial respiration preferably mouth-to-mouth method, each 14 to 16 minutes. If conditions, such as emergency room service, you can rush tracheal intubation, in order to maintain the breathing air or breathing apparatus.
Patients with cardiac arrest has occurred but there is still breathing, the chest should be immediately squeeze the heart, about 80 times per minute. If the carotid artery or femoral artery pulsatility minor hit again, lips lip color from pale to red, indicating that effective. Such as cardiac chest squeeze does not work, should immediately direct thoracic cardiac massage. Injury it is difficult to determine whether or not the site of ventricular fibrillation, and sometimes can not hear heart sounds and no palpable pulse of touch, but may still be weak heart beating. However, if the heart sounds heard in the carotid artery can still see the faint pulse, you may have ventricular fibrillation. This case is necessary external chest compression. In the emergency room, the application to lift the ventricular defibrillation fibrillation. It should be noted that the expansion of the patient's pupil, fixed to the brain is not a reliable indicator of the state, usually it does not mean that brain death. Patients, such as heartbeat and breathing are stopped artificial respiration and cardiac massage should be both at the same time, the ratio of 1:4 ~ 1:5.
If the scene conditions and carrying out artificial respiration and cardiac massage can be applied Lobeline, caffeine, such as central stimulants Coramine. Such as cardiac arrest, cardiac massage in the intravenous injection of adrenaline at the same time. When the ECG confirmed ventricular fibrillation, epinephrine and other drugs can be applied to non-synchronous DC defibrillator later. Such as cardiac arrest is only weak, ventricular fibrillation was found when忌用epinephrine and isoproterenol, which can function to increase cardiac stress, more cause ventricular fibrillation.
Third, check
At the same time during the recovery can be a simple attempt to understand the history, such as the supply current, voltage, current import, contact time, whether there have been electric arc or spark, to the situation, there are not falling at the scene and taken to the emergency services. Check whether the whole body, including rare visceral abdominal injury, with or without fractures, especially the humerus, clavicle and the vertebrae, the site of suspected fractures and chest X-ray examination should be held. Injured patients may have short-term coma, other neurological symptoms can be dizziness, nervousness, and tetany, such as spinal cord injury, and tetany tetany when dealing with anti-line. ECG should be held in check, especially for current patients of imports in the left arm. Such as ECG changes, should be held in continuous ECG monitoring. Determination of arterial blood gas, LDH, CPK, and serum amylase. To stay or catheterization to check for urine myoglobin, hemoglobin.
IV infusion therapy
High-voltage electrical injury, the deep tissue injury of the great effusion, and body surface area burn is not an arrangement in accordance with the infusion. During the infusion treatment, based on the patient's response to the infusion therapy, including the hourly urine output, peripheral circulation and monitoring of central venous pressure. Due to the large number of muscle injury, myoglobin release of a large number of patients after injury of the urine color was wine or soy sauce color, in order to promptly free myoglobin and hemoglobin body in order to reduce the stimulation of renal injury, the prevention of acute renal failure began to enter a larger volume of liquid to ensure that patients in more than 50ml per hour, mannitol should be used. Tyler argued that the beginning of a dose of 25g, after 12.5g / h, with 5 ~ 6h in order to enable urine to reach 200 ~ 300ml / h. 6h usually application usage per 25g (25% 125ml). In addition, 5% sodium bicarbonate should be used to prevent alkalization of urine myoglobin and hemoglobin from the tubular when the deposition, as well as to correct acidosis. In shock patients, especially those who have cardiac arrest or patients with abnormal ECG, input should be properly controlled to prevent over-infusion, increasing the burden on the heart.
V. eschar and deep fasciotomy
High-voltage electrical injury, as a result of deep tissue injury, a large number of fluid exudation, edema significantly under the fascia, the pressure increase. Increased pressure on the organizations will be obstacles to the cycle and result in more secondary muscle necrosis. Therefore, should be implemented as soon as possible and deep eschar fasciotomy to reduce the gap muscle pressure, improve circulation, or may be under pressure to save some but not necrosis of the muscle. But note that the naked eye can see the extent of limb edema is not a muscle that the pressure gap. Also affect the external inspection of the swelling of the distal limb vascular pulsatility. The serious injury of a limb ① showed mild or moderate edema; ② touch of tension, the hardware; ③ passive finger extension or foot pain; ④ fixed contraction; ⑤ ⑥ palpable pulse less than a remote touch cyanosis; ⑦ again very poor capillary filling.
In the wrist, pressure neuropathy may also occur. Surgery should be to achieve the full depth of that cut deep fascia, so that may be bulging muscles, or achieving its purpose. Cut open the wound can be covered by iodoform gauze and suture, coated with silver sulfadiazine paste and so prevent infection. Such as patients and medical conditions permitting, early surgical exploration, fasciotomy, nerve compression and decompression and debridement can be deal with at the same time.
Sixth, the prevention of infection
As a result of deep tissue damage, necrosis, wound treatment to be open. Anaerobic myositis is a relatively common complication, should be the early application of high-dose penicillin to prevent anaerobic infection until complete removal of necrotic tissue. Application should be routine tetanus antitoxin and tetanus toxoid to prevent tetanus.
7, the wound characteristics of electrical injury and the early treatment
Import current high-voltage electrical injury is a circular depression, coking injury, wax ring with a yellow or off-white leather-like tenacity of the skin, outside the narrow, red, and the edge of the Central Uplift. Likely to import more than one. Larger variation of the size of imports, but that does not reflect the scope of the following organizations and circumstances of injury. The exit of the skin also showed the ring, but smaller, dry. May also be more than one. If unable to shake off their hands the power to reach out a long time, then in charge of the Department of handwritten and there carbonization, dry. Electric shock due to flexor contraction of limb joints in flexion and thus, in the elbow, axilla, popliteal fossa and the groin, the mutual contact of the skin near the joints may have intermittent current through the wound. Wound electric shocks as the most prominent characteristic of small skin wounds, and skin (normal skin) depth of injury is very extensive. Muscle injury are often associated with normal muscle interface clear, dark, irregular浅层次, normal muscle may be shallow, and deep muscle ischemia, necrosis. And their development can be gradual in nature. Disease into multiple embolization, necrosis. In addition, the electrical injury to the chest wall deep muscle and rib and intercostal muscle induced pneumothorax; abdominal visceral injury may be caused by necrosis or perforation of hollow organs, necrosis, such as cystic necrosis, intestinal perforation, liver damage, pancreatitis and so on; head electrical injury often caused by scalp necrosis, the skull exposed, and even full-thickness necrosis of the skull.
Electric shock treatment of facial trauma into positive removal of the first principles of necrotic tissue. A large number of non-dynamic organization, mainly muscle, such as reservations for a longer period, they will be induced liquefaction, necrosis, decay, leading to infection and wound sepsis, and to continue to release the source of myoglobin. Electrical injury patients in stable condition in the cycle of 24 ~ 48h after laparotomy experts. Body should include the deep exploration of bone in the surrounding tissue. Early to judge whether or not muscle power often more difficult life. In some cases, irreversible damage looks healthy, the muscles that may survive is bleak. Only with normal appearance of active bleeding after cutting, in the electrical and mechanical stimulation of muscle contraction can be generated that dynamic. Exploration from the injury near the end of the beginning of the trunk, to the remote in order to shorten the operation time and reduce bleeding. To identify the impact of vascular injury in the scope of the supply of blood circulation, can be pre-operative angiography or surgery to confirm the Bank of China. Only removed when the initial exploration necrosis sure the organization, only the muscles in a wide range of removal only after amputation. Exploration of open debridement of the wound without suture. Tendons, nerves and blood vessels should be retained as far as possible and biological dressings, such as pig skin and allograft skin coverage. After the initial exploration of 24 ~ 48h to re-open the dressing can be removed again without life force of the organization and decided to continue under the circumstances debridement or amputation. Electrical injury as a wound on the other hand, dealt with possible conditions, many health organizations to retain and make use of the same species, and xenogeneic skin graft, free or pedicled flap wound repair and restore function.
In the deal with body parts other than the wound electrical injury should be careful. Early wound debridement should be to avoid injury of chest wall rib periosteum, intercostal muscle necrosis has been removed and the rib head to avoid an open pneumothorax. Dorsal abdominal or trunk electrical injury should be closely observed whether or not visceral injury. All this, should be dealt with under coordination specialist.