Muscles experience involuntary spasms when exposed to alternating high currents. Because the long flexors of the forearm are more powerful than the extensors, victims holding conductors may not be able to release the contact. DC currents, on the other hand, do not have this same effect. All victims of high voltage electrical trauma should be admitted to a unit specializing in care for these individuals, however, prior to transfer, the victim frequently needs to be stabilized. In all patients, intravenous access should be established and a 12 lead ECG performed.
Electrical currents can cause cardiac arrhythmias including cardiac arrest.
Cardiac arrests should be managed with the usual ACLS guidelines. As many of these individuals may have fallen from heights, the cervical spine should be examined for evidence of fracture or dislocation. As in other cases of head injury, this should be presumed present until ruled out. A thorough skeletal examination should be performed, and any fractures and dislocations identified and reduced to improve circulation to marginally perfuse tissues. The bladder should be catherized and urine assessed for myoglobin and free hemoglobin.