NREMT Paramedic Cognitive ExamTraumaHard
A 40-year-old male is found unresponsive after being struck by lightning. He has full-thickness burns to his left arm and leg, and his heart rate is 40 bpm. Respirations are apneic. What is the MOST critical immediate action?
- AInitiate advanced burn care for the full-thickness burns
- BBegin CPR focusing on ventilations and chest compressions
- CEstablish IV access and administer a fluid bolus
- DTransport immediately to a burn center
Show answer & explanationAnswer & explanation
Correct answer: B. Begin CPR focusing on ventilations and chest compressions
Lightning strike victims often experience immediate cardiac arrest or severe dysrhythmias and respiratory arrest. The burns, while severe, are secondary to the life-threatening cardiorespiratory compromise. Immediate CPR, especially ventilations for apnea and compressions for bradycardia/asystole, is paramount.
Why the other options are wrong
- A. Basic burn care can be initiated after life threats are addressed, but it's not the immediate priority over cardiac/respiratory arrest.
- C. While IV fluids are important for burn patients, they are secondary to addressing cardiac and respiratory arrest in a lightning strike victim. Fluid resuscitation is not the immediate concern for bradycardia and apnea.
- D. Transport is important, but not before addressing immediate life threats like cardiac and respiratory arrest with CPR.
Lightning Strike Management
Prehospital management of lightning strike victims prioritizes immediate CPR for cardiac/respiratory arrest, often with a focus on ventilation due to respiratory paralysis, and addressing associated injuries.
- Cardiac arrest is the most common immediate cause of death.
- Respiratory arrest is common due to brainstem stunning.
- Burns are often present but are usually secondary to cardiorespiratory compromise.
Memory trick: Lightning Life: CPR First, Then Burns