Darren Whitcomb, MD, Jorge A. Martinez, MD, JD, Dayton Daberkow, MD


South Med J. 2002;95(11) 

In This Article

Case Report

A 55-year-old man was playing golf when a sudden thunderstorm occurred. He sought refuge from the weather beneath a large oak tree. Lightning struck the tree, and the golfer was thrown several feet. When emergency medical services arrived, he was pulseless and apneic. Advanced cardiac and trauma life support were initiated while the patient was immobilized and intubated. Initially, the victim was in asystole, but his cardiac rhythm converted to ventricular fibrillation after continued cardiopulmonary resuscitation and administration of epinephrine and atropine.

Upon arrival to the emergency department, the patient's Glasgow Coma Score was 3. His pupils were 7 mm bilaterally and unreactive to light. After defibrillation, his vital signs returned with blood pressure of 165/72 mm Hg, pulse rate 105/min, respiratory rate 12/min, and temperature 37.2°F. Physical examination revealed normal pulmonary, cardiac, and abdominal examination. Examination of the extremities showed a 1 x 1 cm macerated area on the pad of the left index finger. There were no other signs of trauma. Neurologic examination remained unchanged.

While in the emergency department, the patient was intubated and given 100% oxygen. Normal saline was administered at 100 mL/hr. Laboratory data showed elevated cardiac enzymes with a total creatine kinase value (CK) of 535 IU/L and troponin of 1.5 ng/mL. The CK-MB fraction was <3%. Urinalysis revealed 10 to 25 red blood cells per high-power field with no casts. Complete blood count, serum electrolyte values, and urine myoglobin level were normal. A toxicology screen was negative for drugs or alcohol. The electrocardiogram showed nonspecific flattening of T waves in leads I, aVL, V5, and V6. Radiographs of the cervical spine and chest and computed tomography of the head were unremarkable. The patient was admitted to the intensive care unit (ICU) with consultation to internal medicine for possible acute coronary syndrome. He remained in the ICU for 3 days, when he had acute cardiac ischemia and renal failure. He died on the fourth day after injury, without any improvement in his neurologic status.


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