Lightning/Lightning Strike Injury

Table of Contents

Aliases

Lightning burn

Patient Care Goals

  1. Identify patient(s) as lightning strike victim(s)
  2. Move to safe area
  3. Initiate immediate resuscitation of cardiac arrest victim(s), within limits of mass casualty care, also known as “reverse triage”
  4. Cardiac monitoring during transport
  5. Treat associated traumatic injuries

Patient Presentation

  1. Lightning strikes may happen in a variety of environmental conditions
    1. Most commonly they occur in outdoor or wilderness circumstances
    2. Golf courses, exposed mountains or ledges and farms/fields all present conditions that increase risk of lightning strike, when hazardous meteorological conditions exist
  2. Lacking bystander observations or history, it is not always immediately apparent that patient has been the victim of a lightning strike
    1. Subtle findings such as injury patterns might suggest lightning injury

Inclusion Criteria

Patients of all ages who have been the victim of lightning strike injury

Exclusion Criteria

No recommendations

Patient Management

Assessment

  1. Respiratory
    1. Apnea
    2. Agonal respirations
    3. Respiratory paralysis
  2. Cardiovascular
    1. Dysrhythmias
    2. Transient hypertension
  3. Neurologic
    1. Seizures
    2. Confusion
    3. Paralysis
    4. Paraplegia
    5. Vertigo/dizziness
    6. Parasthesias
    7. Amnesia
    8. Memory deficits
    9. Anxiety
    10. Fixed/dilated pupils possible (autonomic dysfunction)
  4. Skin
    1. Ferning or fern-like superficial skin burn (“Lichtenberg figures”)
    2. Vascular instability may result in cool, mottled extremities
    3. Frequent first and/or second degree burns
    4. Third degree burns less common
  5. Patient may be in full cardiopulmonary arrest or have only respiratory arrest, as injury is a result of DC current
  6. May have stroke-like findings as a result of neurologic insult
  7. May have secondary traumatic injury as a result of overpressurization, blast or missile injury
  8. 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

Treatment and Interventions

  1. Assure patent airway – if in respiratory arrest only, manage airway as appropriate
  2. If in cardiopulmonary arrest, treat per Cardiac Arrest guideline
  3. Consider IV initiation – Avoid initiation through burned skin
  4. Monitor EKG. Be alert for potential arrhythmias. Consider 12-lead EKG, when available
  5. Consider early pain management for burns or associated traumatic injury [see Pain Management guideline]
  6. If multiple victims present, utilize reverse triage and focus initial efforts on those in cardiac arrest first.

Notes – Lightning/Lightning Strike Injury