Defibrillation success rates for electrically-induced fibrillation: hair of the dog.

Accidental electrocutions kill about 1000 individuals annually in the USA alone. There has not been a systematic review or modeling of elapsed time duration defibrillation success rates following electrically-induced VF. With such a model, there may be an opportunity to improve the outcomes for industrial electrocutions and further understand arrest-related-deaths where a TASER(®) electrical weapon was involved. We searched for MedLine indexed papers dealing with defibrillation success following electrically-induced VF with time durations of 1 minute or greater post VF induction. We found 10 studies covering a total of 191 experiments for defibrillation of electrically-induced VF for post-induction durations out to 16 minutes including 0-9 minutes of pre-shock chest compressions. The results were fitted to a logistic regression model. Total minutes of VF and use of pre-shock chest compressions were significant predictors of success (p < .00005 and p= .003 respectively). The number of minutes of chest compressions was not a predictor of success. With no compressions, the 90% confidence of successful defibrillation is reached at 6 minutes and the median time limit for success is 9.5 minutes. However, with pre-shock chest compressions, the modeled data suggest a 90% success rate at 10 minutes and a 50% rate at 14 minutes.1.

Essentials of low-power electrocution: established and speculated mechanisms.

Even though electrocution has been recognized--and studied--for over a century, there remain several common misconceptions among medical professional as well as lay persons. This review focuses on "low-power" electrocutions rather than on the "high-power" electrocutions such as from lightning and power lines. Low-power electrocution induces ventricular fibrillation (VF). We review the 3 established mechanisms for electrocution: (1) shock on cardiac T-wave, (2) direct induction of VF, and (3) long-term high-rate cardiac capture reducing the VF threshold until VF is induced. There are several electrocution myths addressed, including the concept--often taught in medical school--that direct current causes asystole instead of VF and that electrical exposure can lead to a delayed cardiac arrest by inducing a subclinical ventricular tachycardia (VT). Other misunderstandings are also discussed.

Conduction of electrical current to and through the human body: a review.

OBJECTIVE: The objective of this article is to explain ways in which electric current is conducted to and through the human body and how this influences the nature of injuries. METHODS: This multidisciplinary topic is explained by first reviewing electrical and pathophysiological principles. There are discussions of how electric current is conducted through the body via air, water, earth, and man-made conductive materials. There are also discussions of skin resistance (impedance), internal body resistance, current path through the body, the let-go phenomenon, skin breakdown, electrical stimulation of skeletal muscles and nerves, cardiac dysrhythmias and arrest, and electric shock drowning. After the review of basic principles, a number of clinically relevant examples of accident mechanisms and their medical effects are discussed. Topics related to high-voltage burns include ground faults, ground potential gradient, step and touch potentials, arcs, and lightning. RESULTS: The practicing physician will have a better understanding of electrical mechanisms of injury and their expected clinical effects. CONCLUSIONS: There are a variety of types of electrical contact, each with important characteristics. Understanding how electric current reaches and travels through the body can help the clinician understand how and why specific accidents occur and what medical and surgical problems may be expected.

Electrophysiology of connection current spikes.

Connection to a 60-Hz or other voltage source can result in cardiac dysrhythmias, a startle reaction, muscle contractions, and a variety of other physiological responses. Such responses can lead to injury, especially if significant ventricular cardiac dysrhythmias occur, or if a person is working at some height above ground and falls as a result of a musculoskeletal response. Physiological reactions are known to relate to intensity and duration of current exposure. The connection current that flows is a function of the applied voltage at the instant of connection, and the electrical impedance encountered by the voltage source in contact with the skin or other body tissues. In this article we describe a rarely investigated phenomenon, namely a contact, or connection, current spike that is many times higher than the steady-state current. This current spike occurs when an electrical connection is made at a non-zero voltage time in a sine wave or other waveform. Such current spikes may occur when electronic or manual switching or connecting of conductors occurs in electronic instrumentation connected to a patient. These findings are relevant to medical devices and instrumentation and to electrical safety in general.