Emergency Department Treatment

Standard ALS and trauma treatment principles should be followed. Intravenous access, supplemental oxygen, and continuous cardiac monitoring should be initiated immediately. Lightning victims in cardiac arrest have a better prognosis than do victims in arrest due to trauma or acute myocardial infarction. 16 For this reason, aggressive resuscitative efforts should be taken even after a prolonged anoxic period. Hypotension warrants a search for occult hemorrhage, such as intraabdominal or intrathoracic hemorrhage, and pelvic or long-bone fractures.

Once the primary survey is completed, a careful head-to-toe examination should be performed to identify occult injuries. The cutaneous examination may disclose burns and may help determine the path of the current and locate potential organ injuries. Care for a superficial lightning burn includes cleansing, debridement, application of a topical antimicrobial agent, and administration of tetanus prophylaxis, if indicated. Fasciotomy is rarely indicated, since circulatory disorders are frequently consequences of vasospasm and resolve spontaneously. A careful neurologic examination should be performed to detect motor and sensory deficits. Ophthalmologic (including slit-lamp examination) and otologic examinations should be done to rule out visual and hearing disturbances, as well as tympanic membrane rupture. Abdominal distention due to ileus should be treated with gastric decompression. An acute abdomen may be due to blunt injury and intraperitoneal injury.

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