ReviewLightning injury: A review☆
Introduction
Injuries secondary to lightning strike are rare, and feature an unusual presentation, high mortality, and significant long-term morbidity. The American Burn Association recommends referral to a burn center for victims of lightning strike; thus, burn-care providers should be familiar with the characteristics and treatment of these injuries. This paper will review the epidemiology, physics, clinical presentation, management principles, and prevention of lightning injuries for burn-care providers.
Section snippets
Epidemiology
Lightning strikes the earth more than 100 times each second or 8 million times per day. About 50,000 thunderstorms occur each day that may result in fires and injury (Okafor, 2005 #17708) [91]. Worldwide, lightning strike density is highest in Africa, where some regions experience more than 50 lightning strikes/km2 each year [1]. The risk of being struck by lightning is a function of strike and population densities, as well as terrain features that may protect or expose occupants of a
Lightning physics
Lightning is generated when the voltage difference between a cloud and the ground or another object exceeds 2 million V/m. At this point, arcing occurs. Factors that determine the site and severity of electric trauma include the magnitude of energy delivered; voltage; resistance to current flow; type of current; duration of contact with the current source; and current pathway. The electric current involved in lightning strikes is direct current (DC), as opposed to the alternating current (AC)
Clinical presentation and care
Lightning causes death in 10–30% of casualties, and results in permanent disability in the majority of survivors. Many vital structures may be affected. Persons struck by lightning usually show evidence of multiorgan derangement, with the most dramatic effects involving the central nervous and cardiovascular systems.
Prevention
Clearly, prevention of these highly lethal injuries is paramount. A high level of precaution for individuals working or engaging in recreational activities outdoors during the thunderstorm season must be observed. Travel guides and weather-related websites are good resources for determining the timing and duration of rainy seasons for various locations worldwide. Although lightning is associated with cumulonimbus rain clouds, it may precede the rainstorm and has been known to strike with blue
Resources
Resources for survivors of lightning injury include Lightning Strike and Electric Shock Survivors, International (http://www.lightning-strike.org/), which has been helpful for many survivors and their families with long-term sequelae [78]. Additional information is available from the Lightning Data Center at St. Anthony Hospitals, Denver, CO, USA (http://www.stanthonyhosp.org/), the National Oceanic and Atmospheric Administration (NOAA) of the U.S. government (http://www.noaa.gov/), and the
Conclusion
In summary, patients with lightning injury, like those with high-voltage electric injury, should be considered to have sustained high-energy blunt trauma with certain additional unique features. Airway and cardiopulmonary status must be stabilized and maintained, and patients may require spinal precautions. They should be thoroughly evaluated for blunt trauma, as if they had sustained a high-speed motor-vehicle crash. Large-bore IV access should be obtained, and fluid resuscitation should begin
Conflict of interest
None.
Acknowledgement
This work was funded in part by the Combat Casualty Care research program of the US Army Medical Research and Materiel Command, Ft. Detrick, MD.
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2022, InjuryCitation Excerpt :An evidence-based treatment protocol based on the clinical presentation, risks, and particularities of treating lightning strike patients is presented in Appendix C. Approximately 75% of all lightning strike victims suffer from permanent disabilities [1,4,10,12,25,27,32,34,37,57]. Table 4 indicates which sequelae can present and whether follow-up is required.
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The opinions or assertions contained herein are the private views of the authors, and are not to be construed as official or as representing the views of the Department of the Army or Department of Defense.