Lightning Injuries
Overview
• General
• Lightning Myths
• Severity of injuries
• Triage considerations
• Clinical Findings
• Long term effects
• Prevention
General
• 50,000 thunder storms and 8 million lightning strikes
in any given day
• Lightning strikes earth more than 100 x a sec
• 1000 fatalities worldwide/year
• Recreational injuries are increasing but 25% of
deaths and 29% of injuries are still employment
related
• High Mountain environment = 5x more lightning
strikes per year
Frequency of Injury and Death
• 150 - 250 deaths/year in the U.S.
• 4 - 5 times more injuries
• Lightning kills more people in the US each
year than any other natural disaster
– 55% more deaths than tornadoes
– 41% more deaths that floods and hurricanes
combined
Who Gets Struck?
• In early century most common in farmers
• Now, golfers, climbers, joggers and other
outdoor athletes, and construction workers
• Lightning injuries tend to involve more than
one victim
• 15 % of deaths occur in multiples of 2
• 15% occur in multiples of 3 or more
Lightning Production
• Warm, low pressure air moving through
cool, high pressure air produces static
• The friction of moving air particles within
the cloud causes ionization and complicated
energy charges
Lightning Myths
1) Lightning is always fatal
2) Lightning never strikes in the same place twice
3) Victims remain electrified
4) “Suspended Animation”
5) Lightning injuries are like other high voltage
injuries
Mechanism of Lightning Injury
1) Direct Strike
2) Contact - Person touching object struck
3) “Splash” - lightning jumps from its
pathway and patient becomes pathway
4) Ground current - current spreading radially
through the ground
5) Blunt injury
Severity of Injury
1) AC vs. DC
2) Duration
3) Voltage
4) Amperage
5) Resistance of Tissues
6) Pathway
Alternating and Direct Current
• AC - electron flow changes direction on
cyclic basis ( household current = 60
cycles/sec) - More dangerous
• DC - no change in flow
• Lightning - oscillations are so rapid, in effect
a direct current
• As DC - will cause asystole (not fibrillation)
Flash Over
• The short duration of lightning injury
seldom allows energy time to break down
skin and cause significant internal current
flow or tissue damage
• Small amount of energy “leaks” internally,
disrupting cardiovascular, pulmonary, and
autonomic systems
Triage Considerations
• Major cause of death is cardio-respiratory arrest
• Concentrate on those in arrest
• Absence of arrest, pts are highly unlikely to die
• Ventilation is key if not in arrest
Head and Neck
• > 50% of victims have at least 1 tympanic
membrane ruptured
• Skull fractures and C-spine Injuries
• Disruption of ossicles/mastoid
• Permanent Deafness
• Cataracts - corneal lesions, uveitis,
iridcyclitis, hyphema, retinal detachment
Cardiopulmonary
• Pulmonary Contusion/Hemorrhage
• Numerous Dysrhythmias
• Nonspecific ST changes –
rarely true evidence of infarction
• Hypertension present early –
resolves in 1 - 2 hours
Cardiopulmonary Arrest
• Lightning sends heart into asystole and paralyses
respiratory center in brain
• Automaticity MAY lead to the heart restarting
• Respiratory paralysis lasts longer - leading to a
secondary cardiac arrest
• IF THE PT IS VENTILATED - MAY AVOID
SECONDARY ARREST!!!
Extremities
• Numerous fractures and dislocations reported
• Permanent paresis or paresthesias
• Keraunoparalysis - blue, mottled, cold, and
pulseless extremities due to vascular spasm and
sympathetic nervous system lability
- usually clears in a few hours
Skin
• Burns are usually superficial if present at all
deep burns occur in 5%
• Four types of superficial burns
– Linear - from steam production and flashover
– Punctate - appear as cigarette burns
– Feathering - not true burns, electron showers
– Thermal - from ignited cloths or metal
Other Injuries
• Neurologic
– Sz, Deafness, Confusion/Amnesia, Blindness
• Concussion from shock wave
• Chest pain/muscle aches
• Blunt Abdominal Trauma
• Intracranial Hemorrhages
Delayed Injuries
• Dysesthesias • From Hypoxic Cerebral
• Peripheral neuropathy Damage
• Decreased fine motor – Seizures and Severe
Brain Damage
function
• From Vascular Spasm
• Neuropsychologic
– Spinal Artery Syndromes
changes
– memory difficulties,
depression, anxiety,
insomnia.