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Hawkins E, Gostigian G, Diurba S. Lightning Strike Injuries. Emerg Med Clin North Am 2024; 42:667-678. [PMID: 38925781 DOI: 10.1016/j.emc.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Lightning is a common environmental hazard, and is a significant cause of global injury and death. Care and evaluation should follow general trauma guidelines, but several unique aspects of lightning injuries necessitate deviations from standard care that can improve survival and overall outcomes. When evaluating lightning strike patients, some common injury patterns are pathognomonic for lightning strikes and easy to recognize, while others are subtle and require heightened awareness. While most lightning-related injuries resolve spontaneously, some may have significant long-term symptoms. Anticipatory guidance and specialty referral may be needed for appropriate follow-up, evaluation, and treatment.
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Affiliation(s)
- Eric Hawkins
- Department of Emergency Medicine, Atrium Health Carolinas Medical Center Main, Wake Forest University School of Medicine, Charlotte, NC, USA.
| | - Gabrielle Gostigian
- Department of Emergency Medicine, Atrium Health Carolinas Medical Center Main, Wake Forest University School of Medicine, Charlotte, NC, USA
| | - Sofiya Diurba
- Department of Emergency Medicine, Atrium Health Carolinas Medical Center Main, Wake Forest University School of Medicine, Charlotte, NC, USA
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2
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Farrimond R, Yusuff H, Charlton M. Use of Early Veno-Venous Extracorporeal Membrane Oxygenation Following Lightning Strike-Induced Acute Lung Injury. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00271-4. [PMID: 38890080 DOI: 10.1053/j.jvca.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Rohan Farrimond
- ST7 Anaesthesia and Intensive Care Medicine, Sheffield Teaching Hospitals NHS Foundation Trust
| | - Hakeem Yusuff
- Honorary Senior Lecturer / Consultant in ECMO, ICM and Anaesthetics, Glenfield Hospital, University Hospitals of Leicester NHS Foundation Trust, Leicester, United Kingdom
| | - Matthew Charlton
- ST7 Anaesthesia and Intensive Care Medicine, Sheffield Teaching Hospitals NHS Foundation Trust; Honorary Senior Lecturer / Consultant in ECMO, ICM and Anaesthetics, Glenfield Hospital, University Hospitals of Leicester NHS Foundation Trust, Leicester, United Kingdom.
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Idowu A, Adebolu O, Iyer I. Cardiac Manifestations in Patients Hospitalized For Lightning Strike Injury. Am J Cardiol 2023; 209:55-56. [PMID: 37863113 DOI: 10.1016/j.amjcard.2023.09.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 09/19/2023] [Accepted: 09/27/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Abiodun Idowu
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Olayinka Adebolu
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Indiresha Iyer
- Heart and Vascular Institute, Cleveland Clinic Akron General, Akron, Ohio.
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Iqbal SB, Rao SJ, Pyrgos GJ, Haas CJ, Padmanabhan S. Acute inferior ST-elevation myocardial infarction mimicked by direct lightning strike: a case report. Eur Heart J Case Rep 2023; 7:ytad578. [PMID: 38034938 PMCID: PMC10683038 DOI: 10.1093/ehjcr/ytad578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 12/02/2023]
Abstract
Background Direct lightning strikes are rare, and multiple organ systems can be involved. Prognosis is dependent on the severity of the injury. Severe myocardial injury associated with transient electrocardiogram changes, which have been previously described, is a hazardous complication. Case summary A 35-year-old man with no known past medical history presented unresponsive following a direct lightning strike while sitting in a portable toilet. High-quality cardiopulmonary resuscitation was started in the field, with return of spontaneous circulation (ROSC) after 1 h. Following ROSC, he received volume resuscitation and was maintained on multiple vasopressors. Electrocardiogram showed significant ST-elevations in inferior leads with elevated troponin I, consistent with inferior ST-elevation myocardial infarction. Labs revealed lactic acidosis, hyperkalaemia, acute kidney, and liver injury. Due to concern for plaque rupture, coronary angiography was performed and revealed no obstructive coronary artery disease. Vasopressor support and volume resuscitation were continued for extensive burns covering greater than 30% body surface area. The patient became progressively hypotensive, eventually precipitating pulseless electrical activity arrest. Emergent labs were notable for severe acidaemia. Despite aggressive interventions, he expired due to severe multi-organ failure. Discussion Direct lightning injuries are rare with serious potential complications. Myocardial damage, either from direct electrical insult or from induced coronary vasospasm, can lead to multi-organ system failure.
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Affiliation(s)
- Shaikh B Iqbal
- Department of Medicine, MedStar Health Internal Medicine Residency Program, 201 E University Pkwy, Baltimore, MD 21218, USA
| | - Shiavax J Rao
- Department of Medicine, MedStar Health Internal Medicine Residency Program, 201 E University Pkwy, Baltimore, MD 21218, USA
| | - George J Pyrgos
- Department of Medicne, MedStar Franklin Square Medical Center, 9000 Franklin Square Dr, Baltimore, MD 21237, USA
| | - Christopher J Haas
- Department of Medicne, MedStar Franklin Square Medical Center, 9000 Franklin Square Dr, Baltimore, MD 21237, USA
| | - Sriram Padmanabhan
- MedStar Heart and Vascular Institute, MedStar Franklin Square Medical Center, 9000 Franklin Square Dr, Baltimore, MD 21237, USA
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Denq W, Oshlag B. Cardiac Emergency in the Athlete. Clin Sports Med 2023; 42:355-371. [PMID: 37208052 DOI: 10.1016/j.csm.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Cardiac-related deaths are the leading nontraumatic cause of death in the young athlete. Although there are multiple causes for cardiac arrest in athletes, sideline evaluation and management does not vary. Recognition, immediate high-quality chest compressions, and time to defibrillation are the greatest factors affecting survival. This article reviews the approach to the collapsed athlete, causes for select cardiac emergencies in athletes, preparedness for cardiac emergencies, and return to play considerations and recommendations.
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Affiliation(s)
- William Denq
- University of Arizona, 1501 North Campbell Avenue, Tucson, P.O. Box 245057, AZ 85724, USA.
| | - Ben Oshlag
- White Plains Hospital, 41 East Post Road, White Plains, NY 10601, USA
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Weber S, Kulla M, Lechner R. Herz-Kreislauf-Stillstand im alpinen Gelände. FLUGMEDIZIN · TROPENMEDIZIN · REISEMEDIZIN - FTR 2023. [DOI: 10.1055/a-2003-9092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
ZUSAMMENFASSUNGDie Anzahl von Touristen und Freizeitsportlern in Bergregionen nimmt zu. Im Verhältnis dazu steigt auch die Zahl an Notfallsituationen wie Herz-Kreislauf-Stillstand. Wiederbelebungsmaßnahmen in diesen Umgebungsbedingungen sind anspruchsvoll. Eine besondere Bedeutung in diesem Rahmen hat die prolongierte kardiopulmonale Reanimation.
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Affiliation(s)
- Sebastian Weber
- Klinik für Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm
| | - Martin Kulla
- Klinik für Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm
| | - Raimund Lechner
- Klinik für Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm
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Muacevic A, Adler JR, Lahane V, Batra N. Lightning Strike-Induced Myocarditis. Cureus 2022; 14:e32443. [PMID: 36644050 PMCID: PMC9833809 DOI: 10.7759/cureus.32443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Lightning strikes are frequently encountered and are a major cause of morbidity and mortality. It could impair several organs, but the effects of electric current on the cardiovascular system contribute to the primary cause of cardiorespiratory arrest. These effects can be either transient or persistent, ranging from benign or life-threatening arrhythmias, ischemic injury, myocardial contusion, aortic injury, cardiomyopathy, and ventricular failure. Myocarditis has been an important but not very well-understood cause of cardiac dysfunction. Fulminant myocarditis is defined as patients presenting with severe heart failure, having a duration of <2 weeks of symptoms, and requiring inotropic or mechanical circulatory support. This condition can rapidly lead to hemodynamic instability and death. Resuscitation for a longer time increases the probability of favorable outcomes in young and previously healthy patients. This case report accounts for a case of a healthy young male who was struck by lightning while working on the farm and developed electrocardiographic changes along with positive cardiac biomarkers.
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A shocking injury: A clinical review of lightning injuries highlighting pitfalls and a treatment protocol. Injury 2022; 53:3070-3077. [PMID: 36038387 DOI: 10.1016/j.injury.2022.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/07/2022] [Accepted: 08/10/2022] [Indexed: 02/02/2023]
Abstract
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.
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Tandon K, Tandon R, Gohil A, Vani P, Mori S. Transient cardiomyopathy after the indoor lightning strike. JOURNAL OF PEDIATRIC CRITICAL CARE 2022. [DOI: 10.4103/jpcc.jpcc_100_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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George N, Bandi S, Ganti L, Umansky A, Desai B. Bounced off a Truck Out of the Blue: A Case Report of a Lightning Strike During a Thunderstorm. Cureus 2020; 12:e11534. [PMID: 33354478 PMCID: PMC7746318 DOI: 10.7759/cureus.11534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Lightning strikes are a relatively uncommon emergency department presentation, and due to the very high energy involved, can present quite dramatically, including cardiac arrest. However, as with many chief complaints, sometimes these patients can be discharged home after a benign emergency department evaluation. We present one such case of a male who was struck to the ground by lightning outside his truck, which subsequently caught on fire. He demonstrated the classic Lichtenberg figures associated with a lightning injury that evolved over time but was otherwise hemodynamically stable. After an unremarkable laboratory evaluation and electrocardiogram, he was safely discharged home.
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Affiliation(s)
- Nathan George
- Emergency Medicine, University of Central Florida, College of Medicine, Orlando, USA.,Emergency Medicine, Ocala Regional Medical Center, Ocala, USA.,Emergency Medicine, HCA Healthcare Graduate Medical Education Consortium, Ocala, USA
| | - Sumedha Bandi
- Emergency Medicine, University of Minnesota, Minneapolis, USA
| | - Latha Ganti
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA.,Emergency Medicine, Envision Physician Services, Orlando, USA.,Emergency Medicine, Osceola Regional Medical Center, Kissimmee, USA.,Emergency Medicine, HCA Healthcare Graduate Medical Education Consortium, Emergency Medicine Residency Program of Greater Orlando, Olrando, USA
| | - Aaron Umansky
- Emergency Medicine, University of Central Florida, College of Medicine, Orlando, USA.,Emergency Medicine, Ocala Regional Medical Center, Ocala, USA.,Emergency Medicine, HCA Healthcare Graduate Medical Education Consortium, Ocala, USA
| | - Bobby Desai
- Emergency Medicine, University of Central Florida, College of Medicine, Orlando, USA.,Emergency Medicine, Ocala Regional Medical Center, Ocala, USA.,Emergency Medicine, HCA Healthcare Graduate Medical Education Consortium, Ocala, USA.,Emergency Medicine, Envision Physician Services, Plantation, USA
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Blumenthal R. Injuries and deaths from lightning. J Clin Pathol 2020; 74:279-284. [PMID: 32796053 DOI: 10.1136/jclinpath-2020-206492] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
- Ryan Blumenthal
- Department of Forensic Medicine, University of Pretoria, Pretoria, Gauteng, South Africa .,Department of Forensic Medicine, University of Pretoria, Pretoria, Gauteng, South Africa
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Blumenthal R. Lightning and the Forensic Pathologist. Acad Forensic Pathol 2018; 8:98-111. [PMID: 31240028 PMCID: PMC6474460 DOI: 10.23907/2018.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/14/2017] [Accepted: 01/03/2018] [Indexed: 11/12/2022]
Abstract
This paper explores the pathology caused by lightning. It covers the basic physics and mechanisms of injury of lightning strikes followed by a short discussion. The purpose of this paper is to suggest an approach to the investigation and autopsy of a lightning-related death.
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Artinian BL. The Risks of Electric Currents at Home. Arrhythm Electrophysiol Rev 2018; 7:64. [DOI: 10.15420/aer.2017.7.1.l2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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