A shock, a silence, a pulse—the revival after electrocution

Abstract

Background: Electrical injuries represent some of the most sudden and devastating emergencies in the Emergency Department. A momentary contact with current can halt both heartbeat and breath, demanding immediate, structured resuscitation. Early defibrillation, uninterrupted CPR, and adherence to ACLS algorithms remain the cornerstones of survival.

Case Presentation: A 32-year-old electrician sustained a high-voltage electrocution and arrived pulseless, cyanotic, and in ventricular fibrillation (VF). Resuscitation began instantly following ACLS protocol—three shocks of 200 J each, four cycles of high-quality CPR, intravenous adrenaline 1 mg per cycle, and 300 mg amiodarone IV bolus for refractory VF. After twenty relentless minutes, return of spontaneous circulation (ROSC) was achieved. Post-ROSC management included airway protection with intubation, ventilatory support, correction of severe metabolic acidosis, fluid resuscitation, and noradrenaline infusion for persistent hypotension. Bedside echocardiography revealed a stunned myocardium (EF ≈ 30 %). The patient underwent Targeted Temperature Management and achieved full neurological recovery by day 3.

Summary: Structured, algorithmic resuscitation can turn electrocution-induced cardiac arrest into survival when guided by persistence and teamwork.

Conclusion: This case highlights that even in the silence following electrocution, structured teamwork and disciplined adherence to resuscitation algorithms can restore life and rhythm. The ABCDE approach provided order amid chaos, proving that timely defibrillation and sustained effort can revive both the pulse and the possibility of survival.