Anubis

Welcome back! Glad to see you were able to disconnect for a while and take a breather. Now that you're back it looks like I am going to have to go dig out and dust off my climbing gear so I can handle all those cliffs you seem to wind up on -- at no fault of your own, obviously.

Well I guess we'll have to talk the goat into another story then so we can all hang around and discuss that one after Circumnavigation is finished.

Yeah, I overlooked the fact that his was not a direct strike so the burns might be minmal. However, the rhabdomyolysis could still happen just from the muscle stress from the intense, albeit short, contraction due to the current passing through but as you mentioned we don't know how much actually went through him. I have (fortunately or unfortunately) never had to treat a lightning strike or even high current energy victim as of yet but I do know they would make me very nervous during my ride into the hospital with them. What would be considered a "low level" insertion? NASA has the top of Dean topping out at 9 miles high (NASA Source) so I'm guessing very few planes could fly over that and the ones that could would be of no help to Atlantis. The V-22 technical specs state that the service ceiling is only 25,000 feet (V-22 Tech Specs) which is only around halfway up the eyewall. I bet it could go higher if it had to but probably not for too long and definitely not to the 9 mile mark. Would 25,000 ft be considered "low level" or would it be high enough to avoid most of the bad wind/storms? The other issue is it sounds like the V-22's cabin is not pressurized which could have profound effects on both Shane and Trevor.

I just want to applaud the goat on another well researched and written chapter. While he successfully managed to avoid any cliffs I still think there is a rather steep hill there... Trevor was shot and although it was not all that deep, if the bullet penetrated the abdominal cavity at all that makes controlling the bleeding very difficult because it can just bleed into his belly even if they bandage the wound on the surface. Let's hope that this bullet only hit the muscle and underlying fascia and did not go any deeper. While he lost a lot of blood the fact that he is young and healthy and still conscious at this point with the bleeding hopefully under control are all very big pluses for him but if he still has some bleeding he'll only be able to compensate for so long. Shane, however, is on very shaky ground. Lightning strikes can be very, very bad. As was mentioned in the story, lightning can cause all sorts of heart problems (Ventricular fibrillation and asystole being the most common I've learned about). Luckily though, the sinoatrial node is rhythmic and even after a depolarization from a lightning strike can resume its pacemaking duties as long as enough cardiac muscle remains viable after the strike to contract on each impulse. It appears that Shane is very lucky because his heart resumed its automaticity pretty quickly AND his nervous system was still functional to the point he could breath and even respond a little. I'm afraid that's where the good news ends. Due to the amount of electricity that went through his body Shane could have some serious underlying trauma including fractured bones (think neck and spine along with that) and even worse, a lot of damaged tissue. The damaged tissue can come from burns and also just stressing the muscles too much. All of this leads to cellular break down which releases toxic metabolites, potassium, and in the case of muscle myoglobin into the blood. If his potassium gets too high in his blood his heart will stop and CPR will not bring it back this time. The myoglobin can 'clog' his kidneys and cause acute renal failure (usually a later sign). To help all of this Shane needs medical care and the longer he waits the higher his chances of dying are. He needs at minimum an IV so he can get 1.5 L/hr of fluid and some bicarbonate to help flush all of this out of his body. While this might not be a cliffhanger there definitely is a deadfall that we should look out for. The only way out of this with Shane surviving (if he sustained that kind of damage) is a rescue inside the eye BEFORE they make landfall. Also, kudos on the explanation between chest-compression-only CPR and the traditional method. The American Heart Association is pushing chest-compression-only CPR because most cardiac arrests are cardiac events (i.e. it was something wrong with the heart). The rationale behind this is that on inspired air the lungs receive around 21% oxygen. During exhale there is something like 14-16% oxygen (depending on the source you read) left in the air. During a cardiac arrest there is more than enough oxygen in the blood to last several minutes without another breath; it just isn't circulating. Along with that, it takes 5-6 good compressions to resume a coronary perfusion pressure that is life sustainable; each pause in compressions is detrimental to survival. The exceptions to this are anything that could have a respiratory cause because if there is a problem with the respiratory system then there is most likely not enough oxygen in the blood at the time of the cardiac arrest. Children are included in the group of "use regular CPR" because the majority of cardiac arrests in children are respiratory in nature (i.e. they stopped breathing and then the heart stopped).

Maybe they could rig up some of the sail from Atlantis and go windsurfing?

While a trauma arrest is pretty much only solved by bright lights and cold steel (surgery) the field treatment for such would be CPR and/or defibrillation (if it was one of the rhythms that can be shocked--"flatline" can't be shocked) along with other advanced life saving treatments that they don't have access to. However, one could argue that since Trevor was outside and possibly in contact with some sort of metal that could have conducted some of the current then that could be what caused the arrhythmia. If we are really lucky hopefully the current exited his body through the wound helping cauterize some of the vessels thus slowing the bleeding. But I'm not holding out much hope for that since it was the goat himself who said it was Shane who was in most danger. The only thing I can think of to take some of that danger away is that maybe Shane was wearing some of the protective weather gear they had and maybe insulated himself against most of the current. 100 foot seas? There are some people who would pay to get to surf a wave that big... Since they don't have a life raft or zodiac anymore they just need to take the surfboards and ride it in to the Jamaican shore... Better odds than staying on Atlantis.

Unfortunately while automated external defibrillators (AEDs) have proven to be very effective they are not as widely distributed as would benefit the population. While their prices have come down a lot, most of them still go for over $1,000 USD and are not updated or maintained like they should be after purchase. I would think that most larger cruise lines have one or more on their ships but a small charter service like Trevor has most likely would not. Besides, even if he did have one, it was not on the list of things to be placed in the microwave so it is most likely fried just like most of the other electronics at this point.

I see this thread has been inactive for a while. I was just wondering if Linxe has been able to get past that writers block but more importantly if he's okay? I also wanted to take the time to say that I recently found this story and find it to be on my list of favorites. Hope everything is well.