Electrical injuries are a commonly encountered hazard in both the home and workplace. However, clinicians are often uncomfortable when faced with the patient who presents with an electric shock due to sparse literature and lack of systematic recommendations on this topic. Electrical injuries can range from minor skin burns to life threatening internal organ damage. A thorough clinical assessment to ascertain the path of current through the body and possible internal injury is essential. The main concern in an apparently stable individual after an electric shock is the potential for delayed occurrence of cardiac arrhythmias which will require monitoring in the intensive care setting. While it may be reasonable to discharge home from the emergency room selected patients with low voltage injuries, absence of syncope and a normal ECG, others may require monitoring for at least 24 h. Public education and increasing workplace as well as home safety measures are key steps in prevention. The present review summarizes current knowledge in pathophysiology, manifestations and management of electrical injuries, with specific focus on cardiac effects.

Recent studies have shown that in more than half of apparently unexplained sudden cardiac arrests (SCA), a specific aetiology can be unmasked by a careful evaluation. The characteristics and the extent to which such cases undergo a systematic thorough investigation in real-life practice are unknown. Data were analysed from an ongoing study, collecting all cases of out-of-hospital cardiac arrest in Paris area. Investigations performed during the index hospitalization or planned after discharge were gathered to evaluate the completeness of assessment of unexplained SCA. Between 2011 and 2016, among the 18 622 out-of-hospital cardiac arrests, 717 survivors (at hospital discharge) fulfilled the definition of cardiac SCA. Of those, 88 (12.3%) remained unexplained after electrocardiogram, echocardiography, and coronary angiography. Cardiac magnetic resonance imaging yielded the diagnosis in 25 (3.5%) cases, other investigations accounted for 14 (2.4%) additional diagnoses, and 49 (6.8%) patients were labelled as idiopathic ventricular fibrillation (IVF) (48.7 ± 15 years, 69.4% male). Among those labelled IVF, only 8 (16.3%) cases benefited from a complete workup (including pharmacological testing). Younger patients [odds ratio (OR) 6.00, 95% confidence interval (CI) 1.80–22.26] and those admitted to university centres (OR 3.60, 95% CI 1.12–12.45) were more thoroughly investigated. Genetic testing and family screening were initiated in only 9 (18.4%) and 12 (24.5%) cases, respectively. Our findings suggest that complete investigations are carried out in a very low proportion of unexplained SCA. Standardized, systematic approaches need to be implemented to ensure that opportunities for specific therapies and preventive strategies (including relatives) are not missed.

Background— Using automated external defibrillators (AEDs) that implement the Guidelines 2000 resuscitation protocol constrains administration of cardiopulmonary resuscitation (CPR) to <50% of AED connection time. We tested a different AED protocol aimed at increasing the CPR administered to patients with out-of-hospital cardiac arrest. Methods and Results— In a randomized controlled trial, patients with out-of-hospital cardiac arrest requiring defibrillation were treated with 1 of 2 AED protocols. In the control protocol, based on Guidelines 2000, sequences of up to 3 stacked countershocks were delivered, with rhythm analyses initially and after the first and second shocks. The study protocol featured 1 minute of CPR before the first shock, shorter CPR interruptions before and after each shock, and no stacked shocks. The primary end point was survival to hospital admission. Of 5107 out-of-hospital cardiac arrest patients connected to an AED, 1238 required defibrillation, and 845 were included in the final analysis. Study patients (n=421) had shorter preshock pauses (9 versus 19 seconds; P <0.001), had shorter postshock pauses (11 versus 33 seconds; P <0.001), and received more CPR (61% versus 48%; P <0.001) and fewer shocks (2.5 versus 2.9; P <0.001) than control patients (n=424). Similar proportions survived to hospital admission (43.2% versus 42.7%; P =0.87), survived to hospital discharge (13.3% versus 10.6%; P =0.19), achieved return of spontaneous circulation before physician arrival (47.0% versus 48.6%; P =0.65), and survived to 1 year ( P =0.77). Conclusions— Following prompts from AEDs programmed with a protocol similar to Guidelines 2005, firefighters shortened pauses in CPR and improved overall hands-on time, but survival to hospital admission of patients with ventricular fibrillation out-of-hospital cardiac arrest did not improve. Clinical Trial Registration— http://www.clinicaltrials.gov. Unique identifier: NCT00139542.