I have a very odd request. I am a comic book writer working on a story about a young man aged 23 who is struck by lightning. His heart stops beating but his co-workers perform CPR and bring him back. He is rushed to the nearest ER in NYC. This is the part where I need some help. I need for a real life doctor to tell me what they would do for a lightning strike victim if brought into the ER. This comic book will cover about four pages of him being brought into the ER and worked on and then released. What I need is the following: First page will show him coming in on a gurney on wheels. There are four panels -- a panel is a square or rectangle with artwork inside it. I would need some medical dialog for this page. Such as: A doctor telling a nurse what to do and or two doctors talking to each other, etc. Page 2, 3, and 4 are up to you to decide what each panel should show and what would be the medical dialog be on each page, etc. Would this patient go to the ICU or up to X-Ray or somewhere? Please just give me some basic outline of how to draw and write 4 pages. Thank you.
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replied May 12th, 2013
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A lightening strike can cause several problems. It is an electrical current seeking a ground. So, if it crosses the heart, it can cause the heart to stop beating.

If it does not cross the heart, the heart will be fine, but the current is still seeking somewhere to exit the body.

This is where the exit wound is found. It can be anywhere on the body, but usually it is in one of the feet. This is a explosive type of wound, as the current exits the body, causing a grounding of the current.

Lightening strikes act just like an electrical current. So, you can see burns where the current entered and exited the body.

Also, usually just CPR will not restart the heart in this type of injury. It usually takes a "jump" from a defibulator. There is a portable lifesaving device, called an "automated external defibrillator" or "AED".

Anyone can buy an AED, and you will see these all over the hallways of hospitals and also in office building, factories, etc. Some people carry one in their car, with other emergency medical "stuff".

Acute cardiac arrest is a “shockable” type of arrest. Just CPR will not do the trick. It helps until a shock can be delivered. But, the shock has to be within minutes. It is very rare for a patient to be revived after about 10 minutes of CPR.

Now, sometimes a “thump” to the sternum, over the heart, will cause the heart to start beating again. I’m sure you have seen movies or TV shows where a person hits the patient’s chest from about a foot height (a thump). It actually works sometimes.

As to what would be done in the ER (assuming the patient is breathing and has a heart beat) is basically standard. Most physicians will follow the protocols outlines by ATLS (advanced trauma life support).

Usually, the team involved in receiving a trauma patient does not have to be told what to do. They know what needs to be done. However, if the patient is taken to a very small hospital, which is not used to receiving a trauma patient, then the physician may have to tell his assistants what to do.

Usually, the physician or lead nurse will receive a report from the paramedic that is bringing the patient in. So the gurney is rolled over to a bed and the patient is transfer to an ER bed. After the patient is transferred to the bed, the first thing would to be place all of the monitors on the patient, as the physician listens to the patient’s heart and lungs (after the report is finished).

The monitors would be the blood pressure cuff around the upper arm. The cardiac monitors are the three to five sticky pads placed on the chest. And lastly a pulse ox, which is applied to the finger (it measures the oxygen in the blood).

As the monitors are being placed, all the patient’s clothing is cut off.

Two large bore IV’s need to be placed, with Lactated Ringers flowing, if the paramedics have not already placed them in the ambulance.

Then the physician looks at the monitors to decide if the patient needs anything done immediately. Like a transfusion, more fluids, a chest tube placed, etc.

Then the physician does a head to toe physical. All orifices get looked into, finger placed, or a tube placed (ie the eyes, ears, nose, rectal, and urethera). This is where other external wounds are found. The whole patient has to be looked over, including rolling the patient to look at the back.

In trauma patients, usually three x-rays will be taken: A cross table x-ray of the cervical spine, A chest x-ray. And a pelvic x-ray. These are standard.

If the physician finds other injuries, then x-rays of the part can be ordered. So, if there is an exit wound on the leg or foot, that area will usually be x-rayed also, because electrical currents exiting the body can fracture bones.

Once the physician has finished the initial survey, he/she can do the secondary survey which takes care of the injuries or conditions found on the initial survery.

The exit wound will need cleaning and dressing, until a surgeon can look at it. Usually, exit wounds will need to be evaluated and treated by a general surgeon and/or an orthopedic surgeon.

There will usually be burns around the entrance and exit wounds. These can cause a lot of tissue death. In some cases there can be death of the muscles/nerves around the wounds. These wounds will need to be cleaned and dressed until they can be seen by a surgeon.

The above would all be done in the ER. The x-rays are done by portable machines. The physician who receives the patient may ask for the specialists to be called when he first hears the report from the paramedic that brought the patient in, or he/she can go ahead and do the initial survey and then call for the specialists (general surgeon, orthopedic surgeon, cardiologist).

Once the patient is stabilized, he is usually transferred to the ICU for one-on-one care and monitoring. Sometimes, if the wounds need to be debrided, the patient will go directly to the OR for debridement of the dead tissues and treatment of the burns. After surgery, the patient would go to the ICU for monitoring.

The patient may need to go to the OR several times, until all of the tissue death is taken out. But, this may be days down the road. The patient may need to have the burns skin grafted. If the patient has fractures, theses will need to be treated by the orthopedic surgeon.

Hopefully, that will give you enough information. Good luck on your writing.
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replied May 13th, 2013
Thank you very much for that information. If it's okay, I have one more short question, please. If the lightning strike hit the ground a few feet away from the person's foot, is it possible that he might be okay and not have any real damage done to him. Perhaps just a small injury or burn to his foot? And the person would not need CPR? Is that possible?
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