within a short time or shows signs of neurologic deterioration, a computed tomography scan will help exclude intracranial hemorrhage Cardiopulmonary support is nonspecific Most patients resume circulatory stability unless severe hypoxia and ischemia have weakened the myocardium Arrhythmias should be treated along usual lines (see Chapter 86 Cardiac Emergencies ) Patients struck by lightning require only maintenance fluids Patients with ordinary thermal burns should be treated according to standard recommendations (see Chapter 104 Burns ), although body surface area calculations may seriously underestimate fluid requirements It has been noted that burns caused by lightning not usually require special care Extensive vascular and deep tissue destruction may lead to extensive fluid sequestration Isotonic fluid should be given in amounts to maintain normal pulse and BP In all cases, fluids should be given with attention to possible CNS complications