ENVIRONMENTAL EMERGENCIES■ Asystole often resolves spontaneously butif apnea persists →“secondary
death” from hypoxia and (commonly) ventricular fibrillation.
SYMPTOMS/EXAM
■ Cardiac arrest
■ The patient who survives the immediate strike may present with a variety
of findings.
■ Seizures, confusion, amnesia
■ Dysrhythmias: May be delayed
■ Anisocoria or dilated pupils
■ TM rupture, tinnitus, and hearing loss
■ Keraunoparalysis:
■ From sympathetic activation and resultant vasospasm
■ Transient paralysis and blue, mottled, pulseless lower and/or upper
extremities
■ Skin:
■ Lichtenberg figures(see Figure 13.5): Superficial fern or feather pat-
tern from “electron shower”
■ Linear burns: From sweat converting to steam
■ Punctuate burns: Multiple small, round burns
■ Thermal burns
■ Associated traumatic injuries
FIGURE 13.5. Lichtenberg figures.
(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS. Emergency
Medicine: A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill, 2004:1238.)
Lichtenberg figures are
pathognomonic for lightning
injury.