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My Toughest CaseSaving a Lightning-Strike Victim

Janine Kramer, Emergency-Room Physician, Long Island College Hospital

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It was a beautiful Sunday afternoon, and a 27-year-old West Indian immigrant was playing cricket in Marine Park. A violent thunderstorm came out of nowhere, and the team ran for cover. When the patient went back to the field to pick up his equipment, he was struck by lightning.

EMS brought the patient in; he didn’t have a working heart rhythm. There is a small window of time—maybe three minutes—from when the heart stops beating until brain death from lack of oxygen. It wasn’t at all clear if the man would survive. Using CPR and medications, we were able to restart his heart, but the patient had no neurological function—he was unconscious and not responding. He was struck on the top of his head, and the bolt went right through his body. You could see the entrance and the exit wounds and the path the lightning took. The external burns themselves weren’t that bad—it was what the current had done inside. So many organs were involved. The patient was as close to death as possible. None of the staff had ever seen a lightning strike, and I’d only read about it. We were working on the fly. I remember thinking, If I make one wrong move, this could be his finality.

Almost all the large bones of his body were broken, and he had multisystem organ failure: His liver wasn’t functioning, his kidneys were starting to fail, and he was losing blood. As each system was failing, I was like, How are we going to address the fact that the liver is going, and whatever goes wrong next? But first we had to focus on restoring his neurological function. It was not only that he had a lack of oxygen to the brain from the cardiac arrest, but he also had bleeding in both the left and right sides of the brain. That alone required several forms of treatment.

Next we started to stabilize the fractures, and decided to induce therapeutic hypothermia, which is basically a procedure that cools the body so that the heart can recover from the massive injury caused by the cardiac arrest. We cooled the patient down rapidly by irrigating through the bladder and the abdomen, and packing his body in ice. As we were doing this, he started to regain neurological function. He never got enough function to talk, but we could tell that he was spontaneously taking breaths, and he was able to move his eyes and his pupils were reactive. At that point, we knew we had saved his life.

It took five or six hours for the patient to regain a high enough level of function so we could send him to the appropriate facility by ambulance. It wasn’t until he was transferred that I had time to sit and decompress. I called my mom and cried. I don’t know if it was shock or relief. Now, almost a year later, the patient is still in rehab, but he’s walking and talking. I’d say the chances of surviving what he survived are one in a bajillion.


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