Lightning Strike Injury Assessment

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Questions and Answers

What type of burns may require cooling?

Lightning strike burns with Lichtenberg figures

Electrical burns from DC sources

Electrical burns from AC sources

Thermal burns associated with electrical injuries (correct)

What should be done to the patient's clothing in a chemical burn?

Neutralize the chemical on the clothing before removal

Cut away the clothing to prevent further irritation

Remove contaminated clothing and flush with water (correct)

Leave the clothing on to prevent further exposure

What should be done before irrigating dry chemicals or powders from the skin?

Apply a topical antibiotic ointment

Apply a heat pack to the affected area

Brush away the powders or dry agents (correct)

Use a gentle cleaning solution to remove the chemicals

Why should 'neutralizing' chemicals not be used when irrigating chemical burns?

It can cause a heat reaction Signup and view all the answers

What information should be gathered in the event history of an electrical injury?

Type of electrical source, voltage, and duration of exposure Signup and view all the answers

What precaution should be taken when dealing with chemical burns?

Avoid self-injury and take haz-mat precautions Signup and view all the answers

Which of the following is NOT a sign of early deterioration in a patient with a potential traumatic brain injury?

Increased blood pressure Signup and view all the answers

What is the target systolic blood pressure (SBP) for a patient with a traumatic brain injury?

110-120 mmHg Signup and view all the answers

Which of the following conditions would make a patient unreliable for a neuro exam?

All of the above Signup and view all the answers

What is the normal range for pupil size in millimeters?

2-5 mm Signup and view all the answers

What is the normal range for variation in pupil size between the two eyes?

≤ 1 mm Signup and view all the answers

What is the appropriate treatment for a generalized tonic-clonic seizure in a patient with a traumatic brain injury?

Midazolam Signup and view all the answers

What is the appropriate action for a patient with a traumatic brain injury and a GCS score of 8 or less?

Keep the head of the bed flat Signup and view all the answers

What is the preferred method for administering IV fluids to a patient with a traumatic brain injury?

Bolus infusion Signup and view all the answers

What is the appropriate action to take for an eye with a penetrating injury and an impaled object?

Cover the eye with a protective shield Signup and view all the answers

What is a critical sign of a penetrating eye injury?

Peaked pupil Signup and view all the answers

In the management of facial trauma, what should be prioritized to ensure airway patency?

Allow the patient to choose a comfortable position Signup and view all the answers

What should be avoided when assessing nasal injury with rhinorrhea?

Packing the nose to control bleeding Signup and view all the answers

What is the correct method for handling an avulsed tooth?

Rinse under cold water for a brief period Signup and view all the answers

What should be done to minimize edema in facial trauma?

Applying cold packs over the injury site Signup and view all the answers

Which cranial nerves should be assessed for deficits in cases of facial trauma?

CN 5, 7, 8 Signup and view all the answers

What is the recommended action if a patient with facial trauma presents with bleeding from the nose?

Apply pressure to the nostrils for 5-10 minutes Signup and view all the answers

Which of the following conditions warrants immediate transport to a hospital after an injury?

Loss of consciousness and severe headache Signup and view all the answers

What observable sign should be taken seriously if observed following a head injury?

Lying motionless on the playing surface Signup and view all the answers

Which of the following observing behaviors may indicate cerebral impairment?

Showing signs of agitation or restlessness Signup and view all the answers

During a cognitive screening, which question is essential to assess awareness of the event?

What team did you play last game? Signup and view all the answers

Which aspect of cervical spine assessment is critical if neck pain is present?

Full range of active movement without pain Signup and view all the answers

What emotional state observed after a head injury may indicate the necessity for further evaluation?

Emotional flatness or withdrawal Signup and view all the answers

Which response to a question about the current date would indicate a cognitive issue?

Saying a different day from the current one Signup and view all the answers

What sign may indicate a need for urgent care when associated with head trauma?

Severe or increasing headache and vomiting Signup and view all the answers

Which of the following is NOT a consideration when establishing the reliability of a patient?

The patient's age and overall health status Signup and view all the answers

According to the provided content, which of the following is NOT a sign of impending or present ventilatory failure?

Increased blood pressure and heart rate Signup and view all the answers

Which of the following interventions is NOT recommended for a patient with potential shock, as described in the content?

Immediately administering vasopressors to increase blood pressure Signup and view all the answers

Which of the following is the most appropriate intervention for a patient experiencing nausea and vomiting, according to the content?

Administering a standard dose of Ondansetron as per the institution's medication management protocol Signup and view all the answers

What is the target range for end-tidal carbon dioxide (EtCO2) in a patient who needs ventilatory support?

35-45 mmHg Signup and view all the answers

Which of the following is NOT mentioned in the content as a potential risk factor for spinal cord injury (SCI)?

History of previous spinal injuries Signup and view all the answers

Study Notes

Electrical Injuries

Assess for all contact points (entry/exit wounds) and determine if lightning strike was direct, side splash, or ground strike
Wounds often appear as full thickness with reddish, fern-like patterns (Lichtenberg figures) from lightning
No cooling needed unless associated thermal burn; apply dry sterile dressings
Assess for potential associated trauma, including being thrown from contact point and compartment syndrome
Note neurovascular function in all limbs and restrict spine motion per SCI SOP

Chemical Exposure

Obtain history of exposure, including type of chemical, concentration, time, and duration of exposure
Identify body parts exposed and affected, and any first aid measures instituted
Bring in Safety Data Sheets and provide early notice to OLMC if decontamination is needed
Avoid self-injury, take haz-mat precautions, and decontaminate per procedure
Remove contaminated clothing and flush/irrigate affected areas ASAP with clean water or NS

Penetrating Injury/Open Globe

Assess for signs and symptoms, including peaked pupil, excessive edema of conjunctiva, subconjunctival hemorrhage, and blood in anterior chamber
Do not remove retained foreign body, irrigate eye, instill tetracaine, or apply pressure to eye
Cover affected eye with a protective shield or paper cup per procedure
Elevate head of stretcher 45˚

Facial Trauma

Assess for signs and symptoms, including rhinorrhea, oral cavity, nose, and ears for foreign bodies and gross debris
Inspect for malocclusion, inability to open or close mouth, hematoma under tongue, and loose, missing, or broken teeth
Check for motor/sensory deficits (CN 5, 7, 8) and need for SMR
Allow patient to assume position that allows for patent airway
Avoid aspiration/swallowing blood, suction prn, and do not use nasal airway adjuncts if midface trauma or above

ITC Special Considerations

Control epistaxis, collect blood on rolled 4X4 under nose, and do not let patient blow their nose
Assess need for IVF, vomiting/aspiration precautions, and Rx per PAIN Mgt.SOP
Minimize edema, apply cold packs over injury site, and control external soft tissue bleeding per procedure
Preserve tissue per Musculoskeletal Trauma SOP

Neurological Assessment

Assess for signs and symptoms of traumatic brain injury, including confusion, agitation, drowsiness, and severe headache
Perform rapid neuro exam, reassess at least q 15 minutes, and check for:
- Mental status (arousal, orientation, memory, affect, behavior, cognition, insight) and GCS
- Pupil size, shape, equality, and reactivity to light
- VS (BP, pulse pressure, HR, RR, SpO2, EtCO2)
- Pain (headache), dizziness, motor/sensory integrity/deficits, and coordination/balance

Red Flags

If patient is experiencing or has experienced neck pain or tenderness, double vision, weakness/tingling or burning in arms or legs, or seizures, transport to hospital immediately
Observable signs include lying motionless on the playing surface, balance/gait difficulties, disorientation, and facial injury after head trauma

Memory Assessment

Use MADDOCKS questions to assess for amnesia and memory loss
Assess for signs of altered behavior, sensitivity to light or noise, and abnormal behavior (change in personality?)

Cervical Spine Assessment

Check if patient's neck is pain-free at rest and has full range of active pain-free movement
Assess limb strength and sensation, and reassess airway/oxygenation, ventilations, and ability to talk

Airway Management

Prepare for advanced airway with in-line stabilization and/or ventilatory support if airway compromise, RR/depth diminishes, or ventilatory failure is imminent/present
Assess for shock, prevent hypotension, and prevent hypothermia
Manage nausea/vomiting and pain, and titrate carefully to preserve neuro function

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Description

Assessing contact points and wound appearance in lightning strike victims, including Lichtenberg figures and potential associated trauma such as compartment syndrome.