Approach

People with electrical injuries require immediate airway, breathing, and circulation assessment. They should be treated as a multitrauma patient with cervical immobilization at least until the full extent of their injuries has been quantified.[19]​ Prior to determining the patient's cardiorespiratory status, the rescuer must first ensure that the danger of further electrical injury has been removed to allow for a safe environment for assessment.[20]​​

Except for cases of sudden cardiac arrest, lightning strikes generally do not result in immediate injuries that pose a threat to a person's life.[19]​ This implies that individuals who do not experience cardiac arrest when emergency responders arrive are unlikely to die within the next hour. Therefore, priority should be given to administering resuscitation and medical intervention to those who are presumed to be dead initially.[30]

Most patients will have no sequelae from low-voltage electrical injury in the nonindustrial setting and may be discharged following normal ECG and physical examination.

Patients with loss of consciousness, persistent ECG changes, and significant secondary injuries should be admitted to the hospital.[23] Standard supportive care is required.[19]​​

If the person has been injured by an electronic control device (e.g., Taser), treatment is essentially the same as for all electrical injuries. Occasionally, the dart used to deliver the shock, or a fall resulting from the shock, causes additional injury that should be evaluated.[14]

Arrhythmias

People with life-threatening arrhythmias should be treated appropriately with standard ACLS protocols.[31][32]​​ People who are at high risk, such as those with ECG changes, loss of consciousness, and/or high-voltage injuries, will still be advised to undergo 24-hour monitoring.[33]​ People with ECG changes should be monitored for a minimum of 6 hours after injury. People with consistent abnormal ECG readings should be admitted for ongoing monitoring.[34]

People with cardiac arrest and secondary anoxic brain injury may be candidates for targeted temperature control.[35][36]​​​ Guidelines recommend that comatose adult patients with return of spontaneous circulation receive targeted temperature control by selecting and maintaining a constant temperature between 89.6°F and 99.5°F (32°C and 37.5°C) for at least 24 hours.[31][32]​​​[37]

Burns

Cutaneous burns should be placed under cool or lukewarm running water when possible, preferably for 20 minutes.[38] Plain or mild soap can be used to cleanse minor burn wounds. Wounds can then be covered with simple, clean dressings, not necessarily sterile. Cling film can be used as a temporary dressing which is cheap, widely available, and allows subsequent re-examination through the dressing. Early discussion with the local burns team is required to decide if emergency surgery or transfer is required.

Purely electrical burns and flame burns derived from the ignition of clothing tend to be deep-dermal to full-thickness, and are likely to require surgical intervention at some stage. Flash burns derived from electrical arcs are thermal in nature and usually superficial.

Intravenous fluid should be given, but there are no clear guidelines on the amount, as the "rule of nines" does not incorporate the underlying tissue damage in electrical injury.​[39] Fluid resuscitation is guided by blood pressure, pulse rate, urine output, level of consciousness, and central venous pressure monitoring if appropriate.

Tetanus immunization history should be checked, with vaccination and tetanus immunoglobulin considered if the person is not immune.​[40]

Extremity injury

Fractures and dislocations should be appropriately managed.

The limb should be assessed for compartment syndrome, and early surgical intervention with fasciotomy/escharotomy or amputation of a nonviable extremity performed.[29][41]​ See Compartment syndrome of extremities (Management).

If rhabdomyolysis is present, intravenous fluids should be given at a rate that ensures a urine output of at least 1 mL/kg/hour. Definitive management for cases of severe rhabdomyolysis might require renal replacement therapy.[26]​​

Neurologic injuries

Head and spinal injuries should have appropriate neurologic care.

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