Notes – Lightning/Lightning Strike Injury

Lightning/Lightning Strike Injury

Patient Safety Considerations

  1. Recognize that repeat strike is a risk. Patient and rescuer safety is paramount
  2. Victims do not carry or discharge a current, so the patient is safe to touch and treat

Notes/Educational Pearls

Key Considerations

  1. Lightning strike cardiopulmonary arrest patients have a high rate of successful resuscitation, if initiated early, in contrast to general cardiac arrest statistics
  2. There may be multiple victims
  3. If multiple victims, cardiac arrest patients whose injury was witnessed or thought to be recent should be treated first and aggressively (reverse from traditional triage practices)
    1. Patients suffering cardiac arrest from lightning strike initially suffer a combined cardiac and respiratory arrest
    2. Return of spontaneous circulation may precede resolution of respiratory arrest
    3. Patients may be successfully resuscitated if provided proper cardiac and respiratory support, highlighting the value of “reverse triage”
  4. It may not be immediately apparent that the patient is a lightning strike victim
  5. Injury pattern and secondary physical exam findings may be key in identifying patient as a victim of lightning strike
  6. Lightning strike is a result of very high voltage, very short duration DC current exposure

Pertinent Assessment Findings

  1. Presence of thermal or non-thermal burns
  2. Evidence of trauma
  3. Evidence of focal neurologic deficits

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914209 – Injury-Lightning/Lightning Strike

Key Documentation Elements

  • Initial airway status
  • Initial cardiac rhythm
  • Neurologic exam (initial and repeat)
  • Associated/secondary injuries
  • Pain scale documentation/pain management

Performance Measures

  • Cardiopulmonary issues addressed early and documented appropriately
  • Patient transported to closest appropriate facility
  • Pain scale documented and treated per guidelines (when appropriate)
  • EMS Compass® Measures (for additional information, see http://www.emscompass.org)
    • Trauma-01: Pain assessment of injured patients. Recognizing that pain is undertreated in injured patients, it is important to assess whether a patient is experiencing pain
    • Trauma-02: Pain re-assessment of injured patients. Recognizing that pain is undertreated in injured patients, it is important to assess whether a patient is experiencing pain
    • Trauma-04: Trauma patients transported to trauma center. Trauma patients meeting Step 1 or 2* or 3** of the CDC Guidelines for Field Triage of Injured Patients are transported to a trauma center
      • * Any value documented in NEMSIS eInjury.03 – Trauma Center Criteria
      • ** 8 of 14 values under eInjury.04 – Vehicular, Pedestrian, or Other Injury Risk Factor match Step 3, the remaining 6 value options match Step 4

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