Which of the following cardiac arrhythmias is most associated with lightning strikes?
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More people are killed each year in the United States by lightning than by any other natural disaster. Lightning injuries are direct current injuries. They differ from alternating current injuries because victims can suffer from a shock-wave phenomenon that may violently throw them and cause multiple traumas.
Lightning can cause a simultaneous cardiac and respiratory arrest. Typically, patients will have an asystolic arrest due to an immediate and simultaneous depolarization of all myocardial cells. Ventricular dysrhythmias are also possible, but much less common. Spontaneous return of sinus rhythm, typically sinus bradycardia, and the return of spontaneous circulation will often precede the recovery of the respiratory system. A second cardiac arrest due to continued paralysis of the medullary respiratory center may occur if treatment is not initiated promptly.
If multiple lightning victims are present, initial triage and treatment should follow a “reverse triage” system. This is of critical importance, as failure to do so may result in unnecessary and avoidable morbidity and mortality. Those who survive the initial strike rarely die before or after hospital arrival, and initial treatment and resuscitation should be concentrated on those who appear to be in cardiac arrest. Sudden death is most often due to a simultaneous sudden cardiac and respiratory arrest. Often there will be a return of cardiac automaticity in the form of sinus bradycardia with a concurrent return of spontaneous circulation (ROSC) that precedes the recovery of the respiratory system and spontaneous respiration. Given that ROSC precedes the resolution of respiratory arrest, patient ventilation should be supported as soon as possible. This will help reduce the incidence of secondary cardiovascular collapse. During this time, care should be taken to palpate a central pulse, and if not appreciated, CPR may be initiated.
Most lightning strike survivors who appear well without abnormal vital signs or injury requiring hospitalization can safely be discharged. This is true only if they also do not have high-risk findings or history including suspected direct strike, loss of consciousness, focal neurologic complaints, chest pain, dyspnea, major trauma, cranial or significant burns. Appropriate consultation or referral should be obtained for those with ophthalmic, audio-vestibular system, or other injuries as seemingly fit.
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Adult Lab Normals
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