'Thunder bolts and lightning': survival and neurorehabilitation following out of hospital cardiac arrest secondary to lightning strike.

BACKGROUND: There is a limited evidence base to inform patient management following lightning-induced injuries. CASE REPORT: A 36-year-old right-handed Caucasian male struck by lightning while outdoors suffered an out-of-hospital cardiac arrest with a recorded 50-min interval before the restoration of spontaneous circulation. Multiple life threatening injuries were sustained and a profound peripheral neuropathy developed. Cognitively, he was remarkably intact. We document his acute admission and his recovery during an inpatient stay in a UK-based Neurorehabilitation Unit. CONCLUSION: Intensive neurorehabilitation in this case improved functional independence and facilitated neuropsychological recovery, to the point that our patient was discharged to independent living. This case offers some support to the hypothesis that the electrical activity of a lightning strike can be both cardioprotective and neuroprotective, and that prolonged cardiopulmonary resuscitation is warranted in such cases.

Cardiac rhythm recorded by implanted loop recorder during lightning strike.

Lightning strikes cause severe injuries and fatalities. Injuries vary from self-limiting skin manifestations to cardiac arrest and death. Because the event is sudden and unpredictable, assessment of the direct effects of the lightning on the human heart is usually impossible. In this case, a 16-year old boy who had an implanted loop recorder subcutaneous cardiac monitor was hit by lightning during a picnic and survived. A cardiac rhythm strip was recorded live during the strike. SIMILAR CASES PUBLISHED: 0.

Delayed Onset of Atrial Fibrillation and Ventricular Tachycardia after an Automobile Lightning Strike.

BACKGROUND: Lightning strike is a rare medical emergency. The primary cause of death in lightning strike victims is immediate cardiac arrest. The mortality rate from lightning exposure can be as high as 30%, with up to 70% of patients left with significant morbidity. CASE REPORT: An 86-year-old male was struck by lightning while driving his vehicle and crashed. On initial emergency medical services evaluation, he was asymptomatic with normal vital signs. During his transport, he lost consciousness several times and was found to be in atrial fibrillation with intermittent runs of ventricular tachycardia during the unconscious periods. In the emergency department, atrial fibrillation persisted and he experienced additional episodes of ventricular tachycardia. He was treated with i.v. amiodarone and admitted to cardiovascular intensive care unit, where he converted to a normal sinus rhythm on the amiodarone drip. He was discharged home without rhythm-control medications and did not have further episodes of dysrhythmias on follow-up visits. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Lightning strikes are one of the most common injuries suffered from natural phenomenon, and short-term mortality ordinarily depends on the cardiac effects. This case demonstrates that the cardiac effects can be multiple, delayed, and recurrent, which compels the emergency physician to be vigilant in the initial evaluation and ongoing observation of patients with lightning injuries.

[Neurological diseases after lightning strike : Lightning strikes twice]. / Neurologische Erkrankungen nach Blitzschlag : Lightning strikes twice.

Lightning strikes rarely occur but 85 % of patients have lightning-related neurological complications. This report provides an overview about different modes of energy transfer and neurological conditions related to lightning strikes. Moreover, two case reports demonstrate the importance of interdisciplinary treatment and the spectrum of neurological complications after lightning strikes.

Development of a head-phantom and measurement setup for lightning effects.

Direct lightning strikes to human heads lead to various effects ranging from Lichtenberg figures, over loss of consciousness to death. The evolution of the induced current distribution in the head is of great interest to understand the effect mechanisms. This work describes a technique to model a simplified head-phantom to investigate effects during direct lightning strike. The head-phantom geometry, conductive and dielectric parameters were chosen similar to that of a human head. Three layers (brain, skull, and scalp) were created for the phantom using agarose hydrogel doped with sodium chloride and carbon. The head-phantom was tested on two different impulse generators, which reproduce approximate lightning impulses. The effective current and the current distribution in each layer were analyzed. The biggest part of the current flowed through the brain layer, approx. 70 % in cases without external flashover. Approx. 23 % of the current flowed through skull layer and 6 % through the scalp layer. However, the current decreased within the head-phantom to almost zero after a complete flashover on the phantom occurred. The flashover formed faster with a higher impulse current level. Exposition time of current through the head decreases with a higher current level of the lightning impulse. This mechanism might explain the fact that people can survive a lightning strike. The experiments help to understand lightning effects on humans.

Lesions along the upper motor neuronal pathway with locked-in features after lightning strike and cardiac arrest: a case-review analysis.

OBJECTIVE: This study describes a case of lesions of the upper motor neuronal pathway with locked-in features after lightning strike and cardiac arrest. DESIGN: A case-review analysis. METHODS: In a 29-year-old male who was hit by a lightning strike during farming activities, cardiopulmonary resuscitation was provided first by co-workers and continued with success by the medical rescue service. After conducting advanced life support under monitoring and therapeutic hypothermia, quadriplegia with facial diplegia was recognized. A review was undertaken detailing the clinical course. RESULTS: MR imaging presented signs consistent with hypoxia-induced damage and diffusion-weighted MR images revealed pronounced damages along the upper motor neuronal pathway. A reactive electroencephalogram pattern, sustained eye movement and the patient communicating via eye-blinking were interpreted as locked-in features. Two weeks after admission the patient was transferred to a neurological rehabilitation centre for further professional care. CONCLUSION: Direct damage of the upper motor neuron pathway due to the current of the lightning should be considered, albeit the relative contribution of hypoxia-induced damage cannot be separated.

An evidence-based approach to electrical injuries in children.

Electrical injuries, while uncommon, can be associated with significant morbidity and mortality. In children, the injuries tend to occur in the household; in adolescents, they are most often associated with misguided youthful exploration outside the home. Injuries in adults are primarily occupational and due to workplace accidents. Electrical injuries are categorized by their electrical source and can result from low-voltage, high-voltage, lightning strike, or electrical arc exposure. The injury can range from minor to life threatening, and they can cause multisystem complications. High-voltage electrical exposures usually cause severe burns, whereas victims of lightning strikes may have no obvious physical injury but may present in cardiopulmonary arrest. Strategies to prevent electrical injuries have been developed and should be discussed with families and healthcare providers to reduce the incidence of these injuries in children. This review highlights the current literature related to the evaluation and management of children with electrical injuries presenting to the emergency department.

Central hyperadrenergic state after lightning strike.

OBJECTIVE: To describe and review autonomic complications of lightning strike. METHODS: Case report and laboratory data including autonomic function tests in a subject who was struck by lightning. RESULTS: A 24-year-old man was struck by lightning. Following that, he developed dysautonomia, with persistent inappropriate sinus tachycardia and autonomic storms, as well as posttraumatic stress disorder (PTSD) and functional neurologic problems. INTERPRETATION: The combination of persistent sinus tachycardia and episodic exacerbations associated with hypertension, diaphoresis, and agitation was highly suggestive of a central hyperadrenergic state with superimposed autonomic storms. Whether the additional PTSD and functional neurologic deficits were due to a direct effect of the lightning strike on the central nervous system or a secondary response is open to speculation.

Unusual complication in a child with lightning strike: cerebral salt wasting.

Several case reports have presented various neurological complications caused by lightning. However, there was no report related to cerebral salt wasting caused by lightning injury. We described a patient with lightning strike, who was subsequently diagnosed with cerebral salt wasting.

The diagnosis and management of electrical injuries.

Electrical injuries to the extremity can result in significant local tissue damage and systemic problems. An understanding of the pathophysiology of electrical injuries is critical to the medical and surgical management of patients who sustain these injuries.

When lightning strikes: bolting down the facts & fiction.

MYTH: There's no danger from lightning until the rain starts. FACT: Lightning often precedes the storm by up to 10 miles. A reasonable guideline is the "30-30 rule," by which you count the seconds between the flash and the thunder. If the time span is less than 30 seconds, seek shelter. Additionally, wait a full 30 minutes from last lightning flash to resume outdoor activities.

Beyond the basics: lightning-strike injuries.

It is estimated that a lightning flash occurs approximately 8 million times per day throughout the world. Most strikes are benign and cause little damage to property and physical structures; however, when lightning strikes a person or group of people, it is a significant medical and potentially traumatic event that could lead to immediate death or permanent disability. By understanding some basic physics of lightning and pathophysiology of injuries associated with lightning strikes, EMS providers will be better prepared to identify assessment findings, anticipate complications and provide effective emergency care.

Lightning induced atrial fibrillation.

Atrial fibrillation (AF) is a common arrhythmia that occurs in paroxysmal and persistent forms. It occurs in varied situations but lightning induced AF is extremely rare. Here is a case which reverted to sinus rhythm spontaneously. This 37-year-old man without any underlying heart disease had new onset AF after being struck by a lightning. Oral Metoprolol alone was given to control ventricular rate. Spontaneous reversion to sinus rhythm within 36 hours is in favor of new onset lightning induced AF.