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(Circulation. 2005;112:IV-154 – IV-155.)
© 2005 American Heart Association, Inc.

2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Part 10.9: Electric Shock and Lightning Strikes

	Introduction

 
Electric shock and lightning strike injuries result from the direct effects of current on the heart and brain and on cell membranes and vascular smooth muscle. Additional injuries result from the conversion of electric energy into heat energy as current passes through body tissues.

	Background

 
Electric Shock
Factors that determine the site and severity of electric trauma are the magnitude of energy delivered, voltage, resistance to current flow, type of current, duration of contact with the current source, and current pathway.

High-tension current generally causes the most serious injuries, although fatal electrocutions may occur with household current (eg, 110 V in the United States and Canada and 220 V in Europe, Australia, and Asia).¹ Contact with alternating current at 60 cycles per second (the frequency used in most US household and commercial sources of electricity) may cause tetanic skeletal muscle contractions, preventing self-release from the source of the electricity and thereby leading to prolonged exposure. The repetitive frequency of alternating current also increases the likelihood of current flow through the heart during the relative refractory period (the "vulnerable period") of the cardiac cycle. This exposure can precipitate ventricular fibrillation (VF), which is analogous to the R-on-T phenomenon.²

Lightning Strike
The mortality rate from lightning injuries is 30%, and up to 70% of survivors sustain significant morbidity.^3–5 The presentation of lightning strike injuries varies widely, even among groups of people struck at the same time.⁶ In some victims symptoms are mild and require little medical attention, whereas fatal injuries occur in others.^7,8

The primary cause of . . . [Full Text of this Article]