Losing a patient

9/12/07
We just lost a patient this afternoon. She was struck by lightning near the river while bathing her child. She was immediately unconscious. It took them 15-20 min to get here, no CPR. On arrival she was cold and unresponsive, no breathing, no heartbeat, no pulse. We did CPR, got an IV, gave meds and she finally had cardiac rythm. We intubated, gave more meds. The EKG shows a huge inferior myocardial infarction. (common in lightning strikes per our cardiologist). We worked on her for two hours but she never took a breath or responded. The worst is that we have no ventilator here, no ICU, no way to transport her safely to La Ceiba. They say that she would likely not make it to town (the ambulance is a truck with no trained personnel) and even if she did make it with a heartbeat, the track record in La Ceiba is very poor for any critically ill patient surviving. We discussed taking turns bagging her (ventilating her by hand) overnight but our director vetoed that. It is likely that she didn't have oxygen to her brain for 20, maybe 30 minutes. We finally had to call it. She left behind a husband and six children. She was only 34 yrs old.