Defibrillating Asystole in lightning strikes?

[Squad51]

I heard an interesting theory the other day. Defibrillating Asystole in the case of a lightning strike. I heard it from an ER physician, which is why I'm posting this thread. I'm curious as to his reasoning.

Asystole is usually the initial rhythm following a lightning strike. I wouldn't think this would be beneficial, as both the lightning and our defibrillation are DC (Direct Current). In addition, it seems like the defibrillation would increase parasympathetic tone. In theory, prolonging (or ensuring) the patient stays in Asystole. Am I wrong? I haven't been able to find any literature supporting defibrillation in such a scenario. Any thoughts on this?

 

[Veneficus]

I heard an interesting theory the other day. Defibrillating Asystole in the case of a lightning strike. I heard it from an ER physician, which is why I'm posting this thread. I'm curious as to his reasoning.

Asystole is usually the initial rhythm following a lightning strike. I wouldn't think this would be beneficial, as both the lightning and our defibrillation are DC (Direct Current). In addition, it seems like the defibrillation would increase parasympathetic tone. In theory, prolonging (or ensuring) the patient stays in Asystole. Am I wrong? I haven't been able to find any literature supporting defibrillation in such a scenario. Any thoughts on this?

look up the pathophysiology of lightning strikes instead of the treatment.

 

[DrankTheKoolaid]

Also dont forget all asystole is not asystole. It could be fine Vfib mimicking asystole, hence the trial shock. Obviously we dont know what perspective he was speaking from, but I have had the same conversation with local ED Docs here.

 

[SanDiegoEmt7]

A direct current induced asystole would be better treated with transcutaneous pacing than defibrillation in my opinion.

 

[systemet]

As an aside, most defibrillation today is biphasic, making it alternating current (AC) instead of DC. Might make a good name for a band?

 

[mycrofft]

How many prompt EKG's after a lightning strike?

I would bet a nickle the number of times a lightning strike victim was analyzed within even ten minutes of the strike would barely fill a business card.
That said, I'd bet another nickle that any post-lightning asystole (not impossible) would be due to effects and causes NOT related to what usually causes asystole (which would normally be infarcts afecting miocardium and conductive or pacing tissue). Maybe more of a humongously long refractory period?
Anyone have personal experience with this?

 

[Handsome Robb]

Also dont forget all asystole is not asystole. It could be fine Vfib mimicking asystole, hence the trial shock. Obviously we dont know what perspective he was speaking from, but I have had the same conversation with local ED Docs here.

We don't defib fine vfib. I've always been taught to 2 minutes of CPR with it showing on the monitor. Maybe it's another one of those medic school stories "if you shock fine vfib the only change you will see is asystole."

 

[Medic535]

lets face it, when they're flatlined, just about anything is worth a shot. I've seen ER docs shock, pace or shock and pace. Why? Well lets face it, they'e not gonna get any worse.

 

[paramagician]

I thought the inital rhythm after a lightning strike was v-fib? I've also seen ER docs try to pace PEA.

 

[mycrofft]

How many people have a prompt EKG after a lightning strike?

 

[Handsome Robb]

I thought the inital rhythm after a lightning strike was v-fib? I've also seen ER docs try to pace PEA.

That's what I thought as well.

I might be wrong but wasn't pacing an ACLS treatment for asystole back in the day?

 

[Ridryder911]

Until a few years ago, it was part of the ACLS criteria to place patients in aystole for pacing... also PEA (or EMD) syndromes, pacing was part of the treatment.

R/r 911

 

[mycrofft]

I joined Medscape for this:
http://emedicine.medscape.com/article/433084-overview


Moderate lightning injury may cause seizures, respiratory arrest, or cardiac standstill, which spontaneously resolves with resumption of normal cardiac activity. Much of the symptomatology mirrors that of mild lightning injury, except superficial burns are much more common, both initially and in a delayed fashion. These patients may have lifelong symptoms of irritability, sleep disorders, and paresthesias.

Patients with severe lightning injury usually present with cardiopulmonary arrest, which is often complicated by a prolonged period in which they did not receive cardiopulmonary resuscitation (CPR). This delay is attributable to the fact that these individuals are often in an isolated location when injured. Survival is rare in this group unless a bystander expeditiously begins CPR.
Lightning causes asystole, and a sinus rhythm is spontaneously reestablished in some cases. If respiratory support is not provided, however, the patient may go into a secondary cardiac arrest caused by ventricular fibrillation.

Diagnostically:
Early electrocardiography (ECG) is frequently performed, but findings may be normal for the first 24-48 hours. Conduction abnormalities or evidence of subepicardial ischemia is common in more severe strikes.

Also, "they look dead" can be caused by:
"Cold, pulseless extremities are a sign of vasomotor instability"
".. loss of consciousness are a result of the direct passage of current through the brain".
"Fixed and dilated pupils are typically a result of transient autonomic disturbances, not serious head injuries".
And: Lightning Strike and Electric Shock Survivors International:
http://www.lightning-strike.org/DesktopDefault.aspx?tabid=49

See links to other medical sites about lightning treatment.