9.21. LIGHTNING INJURY

Related titles

Burns from a lightning strike.

Purpose of assistance

1. Lightning strike recognition.
2. Moving to a safe area.
3. Initiation of emergency resuscitation of patient(s) with sudden cardiac arrest within the scope of mass casualty care, also known as “reverse triage.”
4. Cardio monitoring during transportation.
5. Treatment of concomitant traumatic injuries.

Description of the patient

1. Lightning can strike under different conditions:

a) this most often occurs in open areas;
b) golf courses, open areas of mountains or ledges and farms/fields are areas of increased risk of lightning strikes if appropriate meteorological conditions.

2. In the absence of witnesses or details of the event, it is difficult to immediately determine whether the strike was lightning. Characteristic injuries may indicate damage by lightning.

Inclusion criteria

Patients of any age after a lightning strike.

Exclusion criteria

No recommendations.

Management of the patient

Status assessment

1. Breathing:

a) apnea;
b) agonal breathing;
c) respiratory paralysis.

2. Cardiovascular system:

a) arrhythmia;
b) transient hypertension.

3. Neurological status:

a) convulsions;
b) disorientation;
c) paralysis;
d) paralysis of two limbs (paraplegia);
d) dizziness;
e) paresthesia;
e) amnesia;
e) memory loss;
g) fear;
h) fixed/narrowed pupils ( autonomic dysfunction).

4. Skin:

a) fern-like burn (Lichtenberg drawing);
b) disruption of blood supply, can lead to cooling and redness of the skin;
c) often present burns of the first and second degree;
d) third degree burns rarely occur.

5. The patient may have complete respiratory and circulatory arrest or only respiratory arrest due to direct current injury.

6. Stroke-like symptoms may be present.

7. There may be secondary damage due to excessive pressure drop, as well as explosive or penetrating trauma.

8. Constricted/dilated pupils can be a sign of stroke more often than a sign of death, so the symptom should not be used as a single, independent sign of death to stop resuscitation.

Treatment and intervention

1. Make sure the airway is open, if only breathing stops, control the airway accordingly.
2. In the event of a sudden stop of blood circulation, act according to the instruction “Cardiac arrest”.
3. Ensure I/O access. Avoid application through burned skin.
4. Monitor the ECG indicators. Remember the possible occurrence of arrhythmias. Record a 12-lead ECG.
5. Provide analgesia as soon as possible, if there are burns or associated injuries (see the instruction “Pain control”).

Patient safety

1. Be aware of the risk of repeated lightning strikes. The safety of the patient and EMD specialists is a priority.
2. Patients do not carry or discharge current, so the patient can be safely touched and treated.

Useful information for training

Key points

1. Patients with cardiopulmonary shock due to a lightning strike have a high chance of successful resuscitation if it is started early, in contrast to the general statistics of cardiac arrest cases.

2. Multiple patients are possible.

3. If there are multiple patients, cardiac arrest patients whose injury is documented or believed to be recent should receive full care first (contrary to traditional triage practice):

a) patients with cardiac arrest due to a lightning strike initially suffer from simultaneous cardiac and respiratory arrest;
b) restoration of breathing can prevent circulatory arrest;
c) successful resuscitation depends on high-quality cardiopulmonary resuscitation, so the triage principle is important.

4. It is not immediately possible to determine whether a patient is a victim of a lightning strike.

5. Characteristic poshkclothing and secondary physical examination can contribute to determining the fact of lightning strike.

6. A lightning strike is a short damage by a direct current of high voltage.

Corresponding evaluation results

1. Presence of burns.
2. Signs of injury.
3. Signs of local neurological disorders.

Key elements of documentation

1. Patility of the respiratory tract.
2. Initial registered heart rate.
3. Results of neurological examination (initial and repeated).
4. Associated/consequential damages.
5. Application of the pain scale according to the guideline “Pain control”.

Criteria for the effectiveness of aid provision

1. Early treatment of breathing and heart problems with proper documentation of actions.
2. Transportation of the patient to the nearest appropriate hospital.
3. Documentary description of the application of the pain sensation scale and the treatment provided, according to the guidelines (if appropriate).