Lightning Injuries 

Assessment

Pediatric Pearls: Signs & Symptoms: Differential: 
□ Use approved reference document for medication dosing, electrical therapy, and equipment sizes.□ Fern-like rash
□ Burns
□ Cardiac Arrest
□ Arrhythmias
□ Compartment syndrome
□ Additional trauma (from patient being thrown)
□ Seizures
□ Confusion
□ Numbness/paralysis
□ Amnesia
□ Fixed pupils (autonomic dysfunction 		□ Medical cardiac arrest
□ Traumatic arrest
□ Stroke
□ Herniation
□ Hypothermia

Clinical Management Options

EMT-B
• Reverse triage-cardiac arrests treated first
• Oxygen, target SpO2 92 – 96% 
•  Identify arrhythmias
• those in cardiac arrest may have excellent outcomes if CPR is started immediately
• Remove constricting clothing or jewelry
• Dress all open wounds
• Assess for additional traumatic injuries
Paramedic
• Vascular access as appropriate for patient condition 
• Obtain EKG
• Pain management
Consult Online Medical Control as Needed

Pearls

  • If multiple victims present, utilize reverse triage and focus initial efforts on those in cardiac arrest first. Patients have excellent survival with CPR
  • Lack of bystanders and patient amnesia can make it difficult to identify lightening scenes. 
  • Monitor EKG. Be alert for potential arrhythmias. Consider 12-lead EKG, when available. Risk of arrhythmias can occur up to 24 hours past event.
  • Fixed/dilated pupils may be a sign of neurologic insult, rather than a sign of death/impending death – Should not be used as a solitary, independent sign of death for the purpose of discontinuing resuscitation in this patient population
  • May have stroke-like findings as a result of neurologic insult
  • May have secondary traumatic injury as a result of overpressurization, blast or missile injury

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