Understanding the principles of lightning injuries

A shocking injury: A clinical review of lightning injuries highlighting pitfalls and a treatment protocol

INTRODUCTION

Lightning strikes have high morbidity and mortality rates. Thousands of fatalities are estimated to be caused by lightning worldwide, with the number of injuries being 10 times greater. However, evidence of lightning injuries is restricted to case reports and series and nonsystematic reviews. In this clinical review, we systematically select, score, and present evidence regarding lightning injuries.

MATERIAL AND METHODS

We performed a systematic search for reviews and guidelines in the PubMed, Embase (OvidSP), MEDLINE (OvidSP), and Web of Science databases. All publications were scored according to the Levels of Evidence 2 Table of the Oxford center for Evidence-Based Medicine. The reviews were also scored using the scale for the quality assessment of narrative review articles (SANRA) and guidelines from the Appraisal of Guidelines for Research & Evaluation (AGREE II).

RESULTS

The search yielded 536 articles. Eventually, 56 articles were included, which consisted of 50 reviews, five guidelines and one overview. The available reviews and guidelines were graded as low to moderate evidence. Most damage from lightning injuries is cardiovascular and neurological, although an individual can experience complications with any of their vital functions. At the scene, initial treatment and resuscitation should focus on those who appear to be dead, which is called the reverse triage system. We proposed an evidence-based treatment protocol for lightning strike patients.

CONCLUSION

It is vital that every lightning strike patient is treated according to standard trauma guidelines, with a specific focus on the possible sequelae of lighting injuries. All emergency healthcare professionals should acknowledge the risks and particularities of treating lighting strike injuries to optimize the care and outcomes of these patients. Our evidence-based treatment protocol should help prehospital and in-hospital emergency healthcare practitioners to prevent therapeutic mismanagement among these patients.

A 9-year retrospective review of lightning deaths from the Eastern Anatolian Region of Turkey

In this study, deaths from lightning strikes in Eastern Turkey revealed distinct patterns in lifestyle and physical injury. Farmers, sailors, and those engaged in outdoor sports are all at risk of being struck by lightning. Death from a lightning strike is associated with cardiovascular and central nervous system damage. This study examines cases of autopsies that were performed on bodies that had suffered a lightning strike, including sociodemographic data, burns on the body, injured regions, histopathological findings, and causes of death. This retrospective evaluation included 17 cases. The cases comprised 88.2% males and 11.8% females, with a mean age of 41.5 years. The person's occupation was farmer in 29.4% of the cases and shepherd in 70.6%. Their deaths occurred most frequently in the summer months. Deaths associated with lightning strikes are more frequent in east of Turkey than in other regions, as agriculture and livestock are common sources of income. The majority of the victims among the cases were males working outside because of their occupations. Histopathologically, subarachnoid fresh bleeding was seen in five cases, subpleural fresh bleeding in the lungs in five cases, and interlobular rupture in the lungs in three cases. Deaths associated with lightning strikes have been correlated with a low level of education in this subject. This study is the largest case study of deaths associated with lightning strikes in Turkey.

Lightning Injury: Changi Hospital Experience

Introduction

Lightning injury is a major concern in Singapore, which has one of the highest incidences of lightning activity in the world. This study examined the frequency and type of lightning injuries that presented to an Accident and Emergency (A&E) department situated in the east of Singapore to identify the groups at risk and the spectrum of injuries sustained.

Materials and methods

This is a case series study with a sample size of 24. Cases that were seen in the A&E department of Changi General Hospital from July 1997 to June 2002 with the International Classification of Disease diagnosis code of E907 for lightning injury were collected and analyzed.

Results

In our study, 83% lightning injuries were work-related and 79% occurred in those below 40 years old. In the work-related category, a significant proportion occurred at the airport (45%) with most of the incidents occurring while working near or in contact with the aircraft (7 out of 9). The other major proportion occurred at construction sites (40%) with a significant number of cases occurring while in contact with cranes (6 out of 8). There was one telephone-related injury. In the non-work related incidents, two out of four occurred while playing golf. Most of the injuries (87.5%) were minor with no long-term morbidity. There was one death and one critical case requiring cardiopulmonary resuscitation. The latter survived and recovered quite remarkably. One patient had serious depression requiring prolonged treatment.

Conclusion

Precaution should be taken during lightning-prone weather conditions in workplaces that involve large metal structures like cranes and aircrafts and in open space. This also applies to recreational sports like golf. Lightning injury, though rare, is not uncommon and emergency room doctors should be conversant with the treatment of this condition and its complications. Immediate basic and advanced cardiac life support administered to a lightning casualty who collapsed can be life saving.

Atmospheric flash injuries in roe deer (Capreolus capreolus)

The pathological and histopathological examination of two female roe deer found dead after a severe thunderstorm is described. One of the two roe deer was killed by a direct hit of atmospheric flash, while the other animal, lying 1.5 m from the first one, died as a consequence of ground current strike. The major part of the coat and skin of the animal that was killed by a direct hit was covered with scorched streaks. The trachea and bronchi of both animals contained a considerable amount of aspirated light-red foam. Necropsy revealed diffuse haemorrhages over the epicardium of the right atrium with a diameter of 1 millimetre. The liver and the kidney exhibited severe congestion.

Case report of a 13-year-old struck by lightning

Lightning strikes kill 1,000 people per year worldwide. Cardiac arrests resulting from lightning strikes have good survival rates but there is a significant degree of morbidity amongst the survivors. This is the case report of a 13-year-old boy who had a cardiac arrest following a direct lightning strike, and his subsequent management.