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.

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.

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.

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.

Lightning injuries in Northern Ireland.

INTRODUCTION: Lightning injuries are uncommon in Northern Ireland (NI) with scarce reports detailing incidence and local experience. We present a case study of 3 patients involved in a single lightning strike with a review of the incidence of similar injuries in the province. METHODS: Data from TORRO's National Lightning Incidents Database between 1987 and 2016 (30 years) were searched to identify victims of lightning injuries in NI. Information on 3 patients with lightning injuries that were managed in our regional burns and plastic surgery service was collected and examined. A supplementary search in hospital records was conducted over the last 20 years to identify additional data. RESULTS: Prior to our study, 6 victims of lightning injuries were identified of whom 5 survived and 1 died. Our 3 patients comprised of 2 children and 1 accompanying adult. All survived but the adult suffered cardiac arrest and required a prolonged period of cardiopulmonary resuscitation. CONCLUSION: While lightning injuries are rare in NI, this is the first report of more than one person affected by a single lightning incident in the province. In our limited experience, immediate public response and prolonged cardiopulmonary resuscitation efforts facilitated by automated defibrillators result in a favourable outcome.

'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.

A rare manifestation of burns after lightning strike in rural Ghana: a case report.

BACKGROUND: Lightning is a natural phenomenon that mostly affects countries in the tropical and subtropical regions of the globe, including Ghana. Lightning strikes pose a global public health issue. Although strikes to humans are uncommon, it is associated with high morbidity and mortality. CASE PRESENTATION: We present a case of a 10-year-old Ghanaian girl who got second-degree burns after being struck by lightning. She was put on an intravenous broad-spectrum antibiotic (ceftriaxone), Ringer's lactate, and her burns were dressed with sterile gauze impregnated with Vaseline (petroleum jelly) and silver sulfadiazine ointment. There was marked improvement on the 16th day of treatment despite the lack in capacity of the hospital to carry out some laboratory diagnostic tests. On the 21st day of treatment, the burns were completely healed without scars and contractures. CONCLUSIONS: This is evidence of burns due to lightning strike, despite its rare occurrence. This report will help inform those in doubt, particularly in communities where lightning injuries are associated with widespread superstition. The case report also revealed how rural healthcare can be challenging amid a lack of basic diagnostic equipment and logistics. However, in resource-limited settings, Vaseline (petroleum jelly) and silver sulfadiazine could be used in the treatment of burns.

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.

Ophthalmic manifestations postlightning strike.

Various ophthalmic complications affecting the anterior and posterior segments have been identified due to lightning strike. We report the first case of an indirect lightning-induced full thickness macular hole formation in the UK as evidenced by slit lamp examination and optical coherence tomography (OCT) scan in a 77-year-old woman presenting with sudden visual loss in her right eye and thermal skin injury affecting her scalp. Her best corrected visual acuities were LogMAR 0.46 and 0.12 in the right and left eyes, respectively. There were no other ocular manifestations observed in either eye. She was initially managed conservatively with non-steroidal anti-inflammatory drug eye drops but surgery was later advised due to minimal changes in the visual acuity and macular hole on follow-up. OCT scanning is important in diagnosing macular holes, which usually warrant surgical intervention.

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.

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.

Tropic lightning: myth or menace?

Lightning is one of the leading causes of death related to environmental disaster. Of all lightning fatalities documented between 2006 and 2012, leisure activities contributed the largest proportion of deaths, with water-associated, sports, and camping being the most common. Despite the prevalence of these activities throughout the islands, Hawai'i has had zero documented lightning fatalities since weather data tracking was initiated in 1959. There is a common misconception that lightning does not strike the ground in Hawai'i. This myth may contribute to a potentially dangerous false sense of security, and recognition of warning signs and risk factor modification remain the most important prevention strategies. Lightning damage occurs on a spectrum, from minor burns to multi-organ dysfunction. After injury, initial treatment should focus on "reverse triage" and immediate cardiopulmonary resuscitation when indicated, followed by transfer to a healthcare facility. Definitive treatment entails monitoring and management of potential sequelae, to include cardiovascular, neurologic, dermatologic, ophthalmologic, audiovestibular, and psychiatric complications.

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.

Lightning burns.

We present the case of a lightning-strike victim. This case illustrates the importance of in-field care, appropriate referral to a burn center, and the tendency of lightning burns to progress to full-thickness injury.

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.