Seizure, A Shocking Effect of a Lightning Strike on Aerodrome: A Case Report.

Lightning injuries have a high morbidity and mortality because of the electrical effects on the circulatory, respiratory, and central nervous systems. Most lightning-related deaths occur immediately after injury due to fatal arrhythmias or respiratory failure. We describe the case of a patient who experienced a seizure and respiratory distress secondary to a lightning strike and how our team was able to stabilize and transport the patient. Ultimately, in this particular case study, the patient survived with minimal residual neurologic and hemodynamic effects. Based on this clinical vignette, we review the pathophysiology of lightning injuries and the predictive factors of positive outcomes in such unusual accidents.

ASIAN ELEPHANT (ELEPHAS MAXIMUS) SUFFERING FROM LIGHTNING STRIKE SUCCESSFULLY TREATED BY INTEGRATIVE VETERINARY MEDICINE.

A captive female Asian elephant (Elephas maximus), approximately 30 yr old, was struck by lightning and displayed obtundation, dysphagia, drooling, and muscle weakness. A physical examination, hematologic test, blood gas analysis, and electrocardiogram were performed. Treatments included the administration of mannitol, dexamethasone, antibiotics, analgesics, vitamins, and intravenous fluid. Conventional therapy resulted in improvement but not complete resolution of clinical signs. Therefore, acupuncture was integrated into the treatment protocol. Electroacupuncture and laser acupuncture were administered every other day; aqua acupuncture was administered once a week. No complications were observed during acupuncture treatment. Acupuncture, a form of traditional Chinese veterinary medicine (TCVM), contributed to the resolution of clinical signs in this case and may be an effective adjunctive treatment for other neurologic disorders in elephants.

'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.

Inducing Therapeutic Hypothermia in Cardiac Arrest Caused by Lightning Strike.

Only limited clinical scenarios are grounds for induction of therapeutic hypothermia. Its use in traumatic cardiac arrests, including those from lightning strikes, is not well studied. Nonshockable cardiac arrest rhythms have only recently been included in resuscitation guidelines. We report a case of full neurological recovery with therapeutic hypothermia after a lightning-induced pulseless electrical activity cardiac arrest in an 18-year-old woman. We also review the important pathophysiology of lightning-induced cardiac arrest and neurologic sequelae, elaborate upon the mechanism of therapeutic hypothermia, and add case-based evidence in favor of the use of targeted temperature management in lightning-induced cardiac arrest.

[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.

A lightning multiple casualty incident in Sequoia and Kings Canyon National Parks.

Multiple casualty incidents (MCIs) are uncommon in remote wilderness settings. This is a case report of a lightning strike on a Boy Scout troop hiking through Sequoia and Kings Canyon National Parks (SEKI), in which the lightning storm hindered rescue efforts. The purpose of this study was to review the response to a lightning-caused MCI in a wilderness setting, address lightning injury as it relates to field management, and discuss evacuation options in inclement weather incidents occurring in remote locations. An analysis of SEKI search and rescue data and a review of current literature were performed. A lightning strike at 10,600 feet elevation in the Sierra Nevada Mountains affected a party of 5 adults and 7 Boy Scouts (age range 12 to 17 years old). Resources mobilized for the rescue included 5 helicopters, 2 ambulances, 2 hospitals, and 15 field and 14 logistical support personnel. The incident was managed from strike to scene clearance in 4 hours and 20 minutes. There were 2 fatalities, 1 on scene and 1 in the hospital. Storm conditions complicated on-scene communication and evacuation efforts. Exposure to ongoing lightning and a remote wilderness location affected both victims and rescuers in a lightning MCI. Helicopters, the main vehicles of wilderness rescue in SEKI, can be limited by weather, daylight, and terrain. Redundancies in communication systems are vital for episodes of radio failure. Reverse triage should be implemented in lightning injury MCIs. Education of both wilderness travelers and rescuers regarding these issues should be pursued.

Inner ear damage following electric current and lightning injury: a literature review.

Audiovestibular sequelae of electrical injury, due to lightning or electric current, are probably much more common than indicated in literature. The aim of the study was to review the impact of electrical injury on the cochleovestibular system. Studies were identified through Medline, Embase, CINAHL and eMedicine databases. Medical Subject Headings used were 'electrical injury', 'lightning', 'deafness' and 'vertigo'. All prospective and retrospective studies, case series and case reports of patients with cochlear or vestibular damage due to lightning or electrical current injury were included. Studies limited to external and middle ear injuries were excluded. Thirty-five articles met the inclusion criteria. Fifteen reported audiovestibular damage following electric current injury (domestic or industrial); a further 15 reported lightning injuries and five concerned pathophysiology and management. There were no histological studies of electrical current injury to the human audiovestibular system. The commonest acoustic insult after lightning injury is conductive hearing loss secondary to tympanic membrane rupture and the most frequent vestibular symptom is transient vertigo. Electrical current injuries predominantly cause pure sensorineural hearing loss and may significantly increase a patient's lifetime risk of vertigo. Theories for cochleovestibular damage in electrical injury include disruption of inner ear anatomy, electrical conductance, hypoxia, vascular effects and stress response hypothesis. The pathophysiology of cochleovestibular damage following electrical injury is unresolved. The mechanism of injury following lightning strike is likely to be quite different from that following domestic or industrial electrical injury. The formulation of an audiovestibular management protocol for patients who have suffered electrical injuries and systematic reporting of all such events is recommended.

Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update.

To provide guidance to clinicians about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the treatment and prevention of lightning injuries. These guidelines include a review of the epidemiology of lightning and recommendations for the prevention of lightning strikes, along with treatment recommendations organized by organ system. Recommendations are graded on the basis of the quality of supporting evidence according to criteria put forth by the American College of Chest Physicians. This is an updated version of the original WMS Practice Guidelines for Prevention and Treatment of Lightning Injuries published in Wilderness & Environmental Medicine 2012;23(3):260-269.

Lightning Strike Injuries.

Lightning is a common environmental hazard, and is a significant cause of global injury and death. Care and evaluation should follow general trauma guidelines, but several unique aspects of lightning injuries necessitate deviations from standard care that can improve survival and overall outcomes. When evaluating lightning strike patients, some common injury patterns are pathognomonic for lightning strikes and easy to recognize, while others are subtle and require heightened awareness. While most lightning-related injuries resolve spontaneously, some may have significant long-term symptoms. Anticipatory guidance and specialty referral may be needed for appropriate follow-up, evaluation, and treatment.

Pediatric electrical burn injuries: experience of a large tertiary care hospital and a review of electrical injury.

A retrospective review of all patients admitted between February 2004 and December 2009, with a diagnosis of burns associated with electrocution, was conducted at The Hospital for Sick Children, Toronto, Ontario, Canada. Data regarding type of electrocution and associated burns were collected. Of the 36 patients identified, 31 (86%) were shocked by electrical current, and 5 (14%) by lightning. Most burns associated with current were first degree (58%). The upper limbs, most frequently the wrist and arm (n = 23), were injured in 26 patients, and the lower limb in 2 patients, whereas 3 patients suffered multiple sites of injury. Twenty-eight patients were treated conservatively with dressings and minor surgical interventions such as debridement and primary repair. The remainder required excision and/or grafting. Fasciotomy and/or escharotomy were performed in 2 patients, and no one required amputation. Burns associated with electrical injuries remain a worldwide problem, responsible for considerable morbidity and mortality. They can usually be prevented through simple safety measures. An effective prevention program would help address this problem.

[Lightning strikes and lightning injuries in prehospital emergency medicine. Relevance, results, and practical implications]. / Blitzschlag und Blitzunfälle in der präklinischen Notfallmedizin. Relevanz, Folgen und praktische Implikationen.

Up to 32.2% of patients in a burn center suffer from electrical injuries. Of these patients, 2-4% present with lightning injuries. In Germany, approximately 50 people per year are injured by a lightning strike and 3-7 fatally. Typically, people involved in outdoor activities are endangered and affected. A lightning strike usually produces significantly higher energy doses as compared to those in common electrical injuries. Therefore, injury patterns vary significantly. Especially in high voltage injuries and lightning injuries, internal injuries are of special importance. Mortality ranges between 10 and 30% after a lightning strike. Emergency medical treatment is similar to common electrical injuries. Patients with lightning injuries should be transported to a regional or supraregional trauma center. In 15% of all cases multiple people may be injured. Therefore, it is of outstanding importance to create emergency plans and evacuation plans in good time for mass gatherings endangered by possible lightning.

Cutaneous Manifestations of Lightning Injury: A Review of the Literature.

Lightning is a rare but potentially devastating cause of injury and mortality. The cutaneous burns associated with lightning strikes demonstrate peculiar pathognomonic signs and patterns. In this review of the literature, we discuss the epidemiology and etiology of lightning injuries, lightning compared to other forms of high voltage electrical injury, the clinical features of lightning injuries, the most common cutaneous manifestations associated with lightning strikes, and the treatment and prevention of lightning injuries. Some of the cutaneous manifestations include feathering lesions, linear burns, punctate burns, and thermal injuries. While not considered true burns, Lichtenburg figures display a unique ferning pattern. Although lightning injuries are typically superficial, transient, and resolve relatively quickly compared to other electrical burns, the ability to recognize their cutaneous manifestations may improve emergent care and life-saving measures for these victims. Additionally, superficial surface burns secondary to lightning injury do not preclude systemic injury and significant pathology may be underlying.

Wilderness medical society practice guidelines for the prevention and treatment of lightning injuries.

To provide guidance to clinicians about best practices, the Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the treatment and prevention of lightning injuries. These guidelines include a review of the epidemiology of lightning strikes and recommendations for the prevention of lightning strikes, along with treatment recommendations organized by organ system. Recommendations are graded based on the quality of supporting evidence according to criteria put forth by the American College of Chest Physicians.

Injuries and deaths from lightning.

This paper reviews recent academic research into the pathology of trauma of lightning. Lightning may injure or kill in a variety of different ways. Aimed at the trainee, or practicing pathologist, this paper provides a clinicopathological approach.

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.

Use of cold intravenous fluid to induce hypothermia in a comatose child after cardiac arrest due to a lightning strike.

We report a case in which mild hypothermia was induced successfully using a cold intravenous fluid infusion in a 12-year-old boy who was comatose following 21 min of cardiac arrest caused by a lightning strike.