A nurse in the emergency department is managing the care of a client who has an electrical shock injury. Which of the following actions should the nurse take first?
A. Change dressings over the entrance and exit wounds.
B. Obtain an ECG.
C. Administer an opioid pain medication.
D. Titrate IV fluids to maintain urine output at 75 mL/hr.
The Correct answer and Explanation is:
The correct answer is B. Obtain an ECG.
Explanation:
Electrical shock injuries can have significant effects on the body, particularly the cardiovascular system. The first priority when treating a client who has experienced electrical shock is to assess for life-threatening conditions, particularly cardiac dysrhythmias, which can result from the electrical current passing through the heart. An electrocardiogram (ECG) is essential to detect any abnormal heart rhythms, such as arrhythmias, which may not present with immediate symptoms but can be fatal if untreated. For example, ventricular fibrillation, a life-threatening arrhythmia, can occur after electrical injuries, and an ECG helps in its early identification and treatment.
While other interventions in the choices are important, the nurse should always prioritize actions that assess and stabilize life-threatening conditions. In this case, since the electrical shock may have caused cardiac dysfunction, obtaining an ECG aligns with the “A-B-C” (Airway, Breathing, Circulation) approach in emergency care, where circulation must be evaluated for any compromise.
- Option A: Change dressings over the entrance and exit wounds – While covering the wounds is important to prevent infection, it is not the first priority. Electrical burns can be severe, but cardiac monitoring takes precedence to rule out immediate life-threatening conditions.
- Option C: Administer an opioid pain medication – Managing the client’s pain is important but does not take priority over assessing potential cardiovascular complications. Pain management is done after ensuring that life-threatening conditions have been ruled out or addressed.
- Option D: Titrate IV fluids to maintain urine output at 75 mL/hr – This is critical in managing potential kidney damage from myoglobin released due to muscle injury (rhabdomyolysis), which is common in electrical burns. However, this action comes after the nurse ensures cardiac function is stable.
In conclusion, performing an ECG as the first action aligns with prioritizing life-threatening conditions in emergency care.