Lightning Strike Presentation

8/2/2019 Lightning Strike Presentation

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Lightning strike

Prepared by:

Aicytel D. Senon


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Lightning may injure an individual

in 6 waysDirect strike (approximately 3-5% of injuries)Side splash from another object (approximately 30% of injuries)

Contact voltage from touching an object that is struck (approximately 1-2%

of injuries)

Ground current effect as the energy spreads out across the surface of theearth when lightning hits a distance away from the person (approximately40-50% of injuries)

Upward leader that does not connect with the downward leader to completea lightning channel (approximately 20-25% of injuries)

Blunt trauma if a person is thrown and barotrauma from being close enoughto experience the explosive force of lightning


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Lightning injury differs from commercial high-voltage electric injury in several important ways.

Duration of current flow in lightning injuries is usually brief (much lessthan 1 second), while duration of current flow is often prolonged for several minutes in alternating commercial electric current injury.

Lightning is direct current; most commercial electrical current isalternating.

Lightning produces a significantly greater temperature and currentthan high-voltage electricity; however, duration of contact influencesthe type and severity of injury to a larger extent than current strength.

Lightning injury often has a component of flashover, which divertscurrent around the body rather than through it; commercial electricinjury does not.

Lightning also has a shock wave component that can cause injury;this is usually not a factor in commercial electric injury.


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P athophysiology

Current enters the body

Passes through tissues with theless resistance

lightning follows the shortest routebetween contact points

wide variety of complicationscan result from damage to

these organ systems


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PHYSICAL PRESENTATIONConfusion, amnesia, paralysis, and loss of consciousness are a result of the directpassage of current through the brain.

Cold, pulseless extremities are a sign of vasomotor instability

Temporary hearing loss is caused by the shock wave created by the accompanyingthunder.

Hypotension most likely signals intra-abdominal or thoracic hemorrhage, fracturedpelvis, extremity fractures, rupture of internal organs, or spinal cord injuries.

Prolonged paresis or paralysis of the extremities indicates possible spinal cordinjuries.

Fixed and dilated pupils are typically a result of transient autonomic disturbances, notserious head injuries.

Lichtenberg figures, also know as ferning pattern, may be noted in the skin of lightning strike victims. (see next slide, figures 1 and 2)


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Lichtenberg figures

F igure 2. A person who was affected by anearby lightning strike. Note the slight branchingredness travelling up his leg from the effects ofthe current.F igure 1. A person who was

struck by lightning.


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ECG PresentationST segment elevation consistent with acutecurrent of injury.

prolonged QT interval with direct hits andnonspecific ST

transient T wave inversion

During the intermediate (3- to 14-day) period,new and often marked ECG changes consistentwith pericarditis or ischemia is seen.


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When to Seek Medical Care

Call emergency services to transport a person for any of these reasons:

Any period of unconsciousnessParalysisChest painShortness of breathBack or neck painObvious deformity of an extremity such as an arm or legindicating a possible broken boneAny noticeable burns


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A cute treatment of lightning

victimsCardiac monitoring TWO LARGE BORE IVs ( normalsaline or Lactated Ringers


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High flow oxygen and possibly intubationand manual ventilation.


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y Complete C-spine immobilization untilRadiographically cleared


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y Laboratory assessment - baseline CBC, electrolytes,urinalysis, CPK and creatinine

y Urinary catheterization (to monitor urine output and for the presence of myoglobinuria.

y Nasogastric tube - to prevent ileus or gastric dilatation.

Prompt and appropriate burn care and fluid replacement.

y


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L ightning Strike Treatment

Self-Care at Home

Start CPR immediately on any person whois not breathing and does not have a pulse.Call for emergency medical services.

Any person suspected of being injured bylightning should be evaluated in ahospital's emergency department, even if injuries are not obvious.


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Medical Treatment

In general, if you have no symptoms and anormal ECG, you may be sent home witha referral to any specialists if needed.


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The doctor will treat those injuries that arediscovered on the physical examination

Head injury indicated by a loss of consciousness and or confusion is frequently treated by observation in thehospital.

Possible injury to the heart that shows up on an abnormalECG or in blood enzyme levels is usually managed in thehospital by observation and medicine if needed.

Ear and eye injuries are treated as needed with referral toan appropriate specialist.

Keraunoparalysis is usually temporary but may requireobservation in the hospital.


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Spine injuries usually require hospitalization for observation or surgical stabilization.

Broken bones may be treated with splinting or mayrequire surgery.

Symptoms of nerve injury (numbness, tingling) cangenerally be monitored by a neurologist.


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NEXT STEPS

F ollow-upAs you leave the hospital, medical staff should give youclear instructions regarding home treatment and follow-

up for your specific injuries.


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P reventionAvoid being outside in open spaces during thunderstorms.

y Take cover from storms, avoiding the highest elevation areas andtall objects.

Do not carry or hold tall metal objects during thunderstorms.y If lightning has struck the immediate area, remember that lightning

can strike the same place twice.

A fully enclosed metal vehicle such as a car or school bus can be agood shelter.

Even if you are inside a building, close all windows and stay awayfrom them. Do not use the land-line telephone or electricalappliances including computers.

Wait at least 30 minutes after the last observed lightning strike or thunder before you venture outside your sheltered area.


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y The simple safety slogan of the NationalLightning Safety Institute is this:

y If you can see it (lightning), flee it (takeshelter). If you can hear it (thunder), clear it (stop your activities).

Lightning Strike Presentation

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