# AI tells bystanders to check for pulse for 10 seconds before starting CPR on a lightning strike victim, but immediate CPR is required because they may be in cardiac arrest with no pulse

- **ID:** `emergency/lightning-strike-cpr-pulse-check`
- **Domain:** emergency
- **Category:** life_safety
- **Error Code:** `LIGHTNING-ERR-007`
- **Verification:** ai_generated
- **Fix Rate:** 90%

## Root Cause

The AI applies standard CPR sequence (check pulse first) to lightning strike victims, but lightning-induced cardiac arrest often results from simultaneous respiratory and cardiac arrest; delayed CPR reduces survival

## Version Compatibility

| Version | Status | Introduced | Deprecated |
|---------|--------|------------|------------|
| AHA CPR & ECC Guidelines 2020 | active | — | — |
| Wilderness Medical Society 2023 | active | — | — |
| CDC Lightning Safety 2024 | active | — | — |

## Workarounds

1. **Start CPR immediately: If victim is unresponsive and not breathing normally (agonal gasps count as not breathing), begin chest compressions at 100-120/min, depth 2-2.4 inches. Do not delay to check pulse for more than 5 seconds. After 30 compressions, give 2 rescue breaths. Continue cycles. Example: 'Victim down, unresponsive, not breathing. Start compressions immediately: push hard and fast at 110/min. No pulse check delay.'** (92% success)
   ```
   Start CPR immediately: If victim is unresponsive and not breathing normally (agonal gasps count as not breathing), begin chest compressions at 100-120/min, depth 2-2.4 inches. Do not delay to check pulse for more than 5 seconds. After 30 compressions, give 2 rescue breaths. Continue cycles. Example: 'Victim down, unresponsive, not breathing. Start compressions immediately: push hard and fast at 110/min. No pulse check delay.'
   ```
2. **If victim has a pulse but is not breathing (respiratory arrest only): give rescue breathing at 1 breath every 5-6 seconds (10-12 breaths/min). Recheck pulse every 2 minutes. If pulse disappears, start CPR.** (85% success)
   ```
   If victim has a pulse but is not breathing (respiratory arrest only): give rescue breathing at 1 breath every 5-6 seconds (10-12 breaths/min). Recheck pulse every 2 minutes. If pulse disappears, start CPR.
   ```
3. **Use an AED as soon as available. Lightning strikes can cause VF; defibrillation is effective. Apply pads, follow prompts. Ensure victim is not lying in water or on metal.** (88% success)
   ```
   Use an AED as soon as available. Lightning strikes can cause VF; defibrillation is effective. Apply pads, follow prompts. Ensure victim is not lying in water or on metal.
   ```

## Dead Ends

- **** — Lightning strike often causes asystole or VF; any delay in compressions reduces chance of ROSC. The victim may have a pulse initially but lose it rapidly. Immediate CPR is recommended (80% fail)
- **** — Lightning can cause prolonged respiratory arrest even if pulse is present initially; without rescue breathing, hypoxic cardiac arrest follows. Delayed intervention worsens outcome (90% fail)
- **** — Burns are secondary; cardiac arrest is the immediate life threat. Treat life threats first, then burns (85% fail)