Lightning Injuries

The electrical charge can cause asystole or other arrhythmias Overview of Arrhythmias The normal heart beats in a regular, coordinated way because electrical impulses generated and spread by myocytes with unique electrical properties trigger a sequence of organized myocardial... read more or cause symptoms of brain dysfunction, such as loss of consciousness, confusion, or amnesia.

Keraunoparalysis is paralysis and mottling, coldness, and pulselessness of the lower and sometimes upper extremities plus sensory deficits; the cause is likely injury to the sympathetic nervous system. Keraunoparalysis is common and usually resolves within several hours, although some degree of permanent paresis occasionally results. Other manifestations of lightning injury may include

Neurologic problems may include confusion, cognitive deficits, and peripheral neuropathy. Neuropsychologic problems (eg, sleep disturbances, attention deficit, memory problems) may occur.

Cardiopulmonary arrest at the time of the strike is the most common cause of death (see Cardiac Arrest Cardiac Arrest Cardiac arrest is the cessation of cardiac mechanical activity resulting in the absence of circulating blood flow. Cardiac arrest stops blood from flowing to vital organs, depriving them of... read more and Overview of Respiratory Arrest Overview of Respiratory Arrest Respiratory arrest and cardiac arrest are distinct, but inevitably if untreated, one leads to the other. (See also Respiratory Failure, Dyspnea, and Hypoxia.) Interruption of pulmonary gas exchange... read more ). Cognitive deficits, pain syndromes, and sympathetic nervous system damage (eg, erectile dysfunction [ 1 Symptoms and signs reference Lightning injuries include cardiac arrest, loss of consciousness, and temporary or permanent neurologic deficits; serious burns and internal tissue injury are rare. Diagnosis is clinical; evaluation... read more ]) are the most common long-term sequelae.

Lightning injuries may be witnessed or unwitnessed. Unwitnessed injuries should be suspected when people found outside during or after storms have amnesia Amnesias Amnesia is partial or total inability to recall past experiences or inability to store new memories after the causative event. It may result from traumatic brain injury, degeneration... read more or are unconscious. All patients struck by lightning should be evaluated for traumatic injuries.

ECG may be done if injury is severe. Cardiac enzymes are measured for patients with the following:

Patients with initially abnormal or deteriorating mental status or focal neurologic deficits compatible with a brain lesion require a head CT or MRI.

Cardiopulmonary resuscitation (CPR) is initiated for cardiac or respiratory arrest or both. If an automated external defibrillator is available, it should be used for cardiac arrest. Patients who are in cardiac arrest Cardiac Arrest Cardiac arrest is the cessation of cardiac mechanical activity resulting in the absence of circulating blood flow. Cardiac arrest stops blood from flowing to vital organs, depriving them of... read more following a lightning strike, unlike patients in cardiac arrest from other types of trauma, often have an excellent prognosis if resuscitated. Thus, unlike in a typical mass-casualty event Overview of Incidents Involving Mass-Casualty Weapons Mass-casualty incidents (MCIs) are events that generate sufficiently high numbers of casualties to overwhelm available medical resources. They include natural disasters (eg, hurricanes) and... read more , in which patients in cardiac arrest are given low triage priority, such patients are given high priority when multiple casualties are caused by lightning strike.

Supportive care is provided. Fluids are usually restricted to minimize potential brain edema. Most patients who have been injured by lightning can be safely discharged unless cardiac effects or brain lesions are suspected.

Most lightning injuries can be prevented by following lightning safety guidelines. People should know the weather forecast and have an escape plan involving evacuation to a safer area (ideally a large, habitable building). They should pay attention to the weather while outdoors so they can implement the escape plan if a storm comes up. By the time thunder is heard, people are already in danger and should seek shelter (eg, in a building or fully enclosed metal vehicle). Small, open structures, such as gazebos, are not safe. People should not go outdoors until 30 minutes after the last lightning is seen or thunder is heard.

When indoors during an electrical storm, people should avoid plumbing and electrical appliances, stay away from windows and doors, and not use hard-wired telephones, video game consoles, computers, or headsets attached by a cable to a sound system. Cellular phones and other handheld devices and laptop computers are safe when used with battery power only because they do not attract lightning.