This handout is for post-cardiac-arrest care — electrical-injury-induced arrest. Your care team identified this based on: rosc after electrical-injury cardiac arrest (high-voltage industrial, lightning, or low-voltage household ac).
Other reasons your team may use this plan: high-voltage (>1000 v) industrial exposure or lightning strike with cardiac arrest — asystole most common (aha 2020 §electrical injury); low-voltage household ac (110/220 v, 50-60 hz) with vf — r-on-t mechanism during vulnerable t-wave window (spies 2006 pmid 17143257).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| norepinephrine | 0.05-0.5 µg/kg/min titrate MAP ≥65 | IV | continuous | SOAP-II PMID 20200382; first-line post-ROSC vasoactive |
| amiodarone | 300 mg IV bolus → 150 mg if recurrent → 1 mg/min × 6h → 0.5 mg/min × 18h | IV | standard ACLS dosing | AHA 2020 ACLS Class IIb; standard cadence (no hypothermia adjustment unless TTM in deep-cool phase) |
| epinephrine | 1 mg IV q3-5 min during arrest | IV | standard ACLS | AHA 2020 ACLS |
| sodium bicarbonate | 150 mEq in 1 L D5W at 150-250 mL/h to target urine pH ≥6.5 | IV | continuous infusion | KDIGO 2012 §5.4 — urinary alkalinization for myoglobinuric AKI prevention; controversial Class IIb but commonly used; monitor pH + bicarb + Ca |
| calcium gluconate | 1-3 g IV over 5-10 min | IV | as needed for hyperkalemia ECG changes | KDIGO 2020 hyperkalemia — membrane stabilization within minutes; precedes shifting therapies |
| insulin regular | 10 units IV with 25 g D50 | IV | as needed for hyperkalemia | KDIGO 2020 hyperkalemia — intracellular K shift; monitor glucose q1h × 4-6h |
| magnesium sulfate | 1-2 g IV | IV | one-time + repeat for TdP | AHA 2020 ACLS Class IIa for TdP; QTc prolongation common in first 24h post-electrocution |
| propofol | 5-50 µg/kg/min | IV | continuous; titrate RASS | PADIS 2018 |
| fentanyl | 25-200 µg/h | IV | continuous | PADIS 2018; analgesia + shivering suppression for TTM |
| tranexamic acid | 1 g IV over 10 min | IV | within 3h of bleeding onset | CRASH-2 PMID 20554319 if traumatic bleeding co-existing with electrocution |
Plan: Electrical-injury post-arrest phenotype — IVF rhabdo bundle + cardiac conduction surveillance + post-ROSC standard bundle (AHA 2020 + Spies 2006 + Bosch 2009 + KDIGO 2012)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Cardiology follow-up at 1-2 weeks for QTc + LV function reassessment; nephrology if AKI persists; PT/OT for deep-tissue + burn rehab; trauma surgery for fracture / spinal injuries; mental health (PTSD risk very high); occupational medicine + workers-comp documentation if work-related; family CPR/AED training; cardiac MRI if suspected channelopathy unmasked or persistent dysfunction
Guideline: AHA 2020 ACLS / Post-Cardiac-Arrest Care electrical injury § + Spies 2006 narrative review + Koumbourlis 2002 + KDIGO 2012 AKI + KDIGO 2020 hyperkalemia + TTM2 + HYPERION + Sandroni 2021 neuroprog