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Of a total of 4,153 admissions, five patients with lightning-associated injuries were admitted to a burn center during a 15-year period, 1969 through 1983. In these patients, the burned portion of the total body surface ranged from 3% to 29% (average, 16%), and all survived. The associated injuries and complications in these lightning-strike victims and a review of treatment guidelines are presented.
Lightning causes more deaths than any other weather phenomenon. It is an electrical current that will choose the shortest paths between the contact points of the human body and may involve vital structures in its pathway. Almost every organ system can be injured by the electrical current of lightning. A broad spectrum of complications resulting from damage to the various organ systems has been reported. The sequelae peculiar to this specific type injury will dictate the choice of therapy.
Electrical damage of the ear can be caused by lightning or by electricity. A 41 year old woman hit by lightning causing burns and rupture of both tympanic membranes is reported and analysed.
The pathophysiology, types, and treatment of electrical and lightning injuries are discussed in detail. Cases of electrical injury almost always eventually involve litigation. Therefore, careful charting of history and physical findings may save the physician court time later. Care of lightning injuries is very different from that of high voltage injuries.
Since 1969, ninety-four persons were reportedly killed annually by lightning in the United States. Reported injuries were almost three times the fatalities. These casualties were not evenly distributed across the country. The purpose of this paper was to examine the expected distribution of these occurrences using known ecologic risk factors. Lightning fatalities and injuries were related to thunderstorm days, population characteristics, and land area. The resulting predicted casualties were mapped and indicate where preventive measures are needed. This same technique could be employed to examine most natural hazard risks using existing data.
Five patient (one adult and four children) hit by lightning strokes were examined clinically and electroencephalographically. One child died immediately after the accident. For the four survivors, data are available which were collected during several years' examinations. It was possible to confirm the results of previous investigations which showed that pathologic EEG changes can be associated with a weak neuropsychiatric symptomatology following the gradual disappearance of the acute lightning-stroke syndrome and can be observed even in the case of freedom from complaints and symptoms. Finally, the authors also deal with the problems associated with the making of statements by medical experts.
We describe a case of bilateral basal ganglia hemorrhage after a lightning strike to the head documented by a CT scan. Review of the literature shows this to be the most common brain imaging finding that can be attributed to a lightning strike. Several mechanistic theories are discussed, with the most plausible one being related to preferential conduction pathways through the brain.
Lightning injury can cause severe damage to many systems and often results in a high mortality. We report a case of sustained lightning injury in which a 54-year-old woman presented with heart failure, pulmonary edema and consciousness disturbance. The patient was found unconscious, lying face down on the ground of a trash dump on the day of a thunderstorm. No deformities were seen in the extremities, but scattered third degree burns (less than 1%) were found on her neck where her necklace had been. Ventilator and inotropic agents with an adequate fluid supply were used. A Swan-Ganz catheter was inserted for monitoring. The patient was discharged two weeks later with an uneventful clinical course, except for mild neurologic sequelae (amnesia, disorientation).
A 40-year-old Thai male was struck by lightning while he was riding his motorcycle during a day of gathering clouds and threatening rain. There were third degree burns around the mastoid areas corresponding to the metal arms of the spectacles, also around the neck where a silver chain with pendant (Buddha image) hung, as well as a full thickness vertical lesion down the center of the chest and abdomen where the zip of the jacket made its mark. Fern-like skin erythema was also seen around the later wound. These are stigmas of lightning skin injuries and the patient survived with no memory of the event.
A previously healthy male was struck by lightning. He developed neurologic deficits, including mild cerebral brain dysfunction. Magnetic resonance imaging (MRI) showed numerous foci of hyperintensity on long TR images, scattered throughout the supratentorial white matter. To our knowledge, the early MRI findings of lightning injury have not been previously reported.
During the years 1991-1993, the emergency department of Arhus Kommune Hospital received four victims of lightning accidents. Two of these were admitted to the intensive care unit for further treatment and observation. This case report brings their histories including clinical findings. Possible mechanisms of damage are discussed and the importance of immediate and continued resuscitation of the presumably lifeless victim of a lightning accident is confirmed. All four patients recovered without serious physical sequelae.
A case of a person struck by lightning is presented in which treatment consisted of 60 min of resuscitation, followed by a 3 day period of artificial ventilation. Persons who are struck by lightning might benefit from prolonged resuscitation efforts, since patients such as this one, as well as similar cases described in the literature, have survived without major sequelae. In our opinion, on-the-spot advanced life support, hypothermia and a moderate rehydration policy contributed to this patient's successful resuscitation.
OBJECTIVE: There have been many reports that spinal anesthesia induces severe lightning pain in the lower limbs of patients with phantom limb pain, tabes dorsalis, or causalgia. We report on a patient with neuropathic pain of central origin who showed newly developed severe lightning pain after therapeutic subarachnoid block (SAB). We performed SAB 16 times in this patient, and he complained of severe pain each time. We investigated which drug was best for treating such induced pain by administering various drugs to the patient. SETTING: The patient was hospitalized for treatment and observation. PATIENT: The patient was a 48-year-old man with neuropathic pain secondary to an incomplete spinal cord injury at the cervical segment. INTERVENTIONS: Various drugs were administered for relieving the newly developed severe pain, and the effectiveness of these agents was compared. RESULTS AND CONCLUSIONS: Intravenous thiopental, fentanyl, butorphanol, ketamine, midazolam, droperidol, and sevoflurane-oxygen anesthesia were quite effective. Intramuscular butorphanol was not effective. Intravenous physiologic saline and atropine sulfate as a placebo, intrathecal morphine hydrochloride, intravenous mexiletine, and lidocaine were ineffective. Intravenous thiopental (approximately 1 mg/kg) was thought to obtain the best pain relief because it stopped the pain quickly, the dose needed was subanesthetic, and there was no adverse effect.
Using a NaI(Tl) scintillation detector designed to operate in electrically noisy environments, we observed intense bursts of energetic radiation (>> 10 kiloelectron volts) during the dart leader phase of rocket-triggered lightning, just before and possibly at the very start of 31 out of the 37 return strokes measured. The bursts had typical durations of less than 100 microseconds and deposited many tens of megaelectron volts into the detector. These results provide strong evidence that the production of runaway electrons is an important process during lightning.
A 74-yr-old man was scheduled for the biopsy of prostatic tumor under spinal anesthesia. Preoperative serologic test for syphilis was highly positive. Spinal anesthesia was performed in the sitting position, and 2 ml of hyperbaric Neo-percamine S (a mixture of 0.24% dibucaine and 0.12% T-caine) was administered uneventfully with the onset of warm sensation on the perineal region. Ten minutes later, however, he began to complain of severe lightning sensation on the feet. After giving pentazocine intravenously, the short cystoscopic procedure was completed. As a cause of severe pain, an erroneous anesthetic solution or direct neuronal injury had been excluded because of rapid and complete recovery after anesthesia. Two weeks later, he was scheduled for TUR-P. He again complained of severe lightning pain after the successful spinal anesthesia with the same anesthetic solution. Because the pain was not relieved by analgesics, he was then anesthetized with enflurane and N2O in oxygen, and there were no neurological complications after anesthesia. Several cases of severe pain during spinal anesthesia have been reported in patients with tabes dorsalis. Although the patient lacks clear symptoms of neurosyphilis, positive serologic examination for syphilis without any other possible causes suggests altered sensitivity of the spinal cord to anesthetic solutions.
In 78 of 103 patients with various vitreo-retinal pathology a peculiar photopsy has been revealed, which was called by the authors photopsy in a form of "side lightning". It appeared as bright arc-shaped light flashes in the periphery of the temporal part of visual field. It is stated that this symptom characterizes posterior detachment of the vitreous, which, in its turn, accompanies many vitreo-retinal diseases. Among 78 patients, 14 had retinal detachment, 52--central vitreo-retinal fibroplastic syndrome, 10--idiopathic macular apertures. In all cases photopsy in a form of "side lightning" was one of leading subjective symptoms. Correct assessment of this symptom favoured a timely diagnosis of vitreo-retinal pathology.
To our knowledge, this article represents the second temporal bone case report in the literature of profound bilateral sensorineural deafness resulting from a lightning strike to the neck. Initial survival permitted antemortem audiologic testing, the results of which suggested severe cochlear abnormalities. Both temporal bones showed widespread inner-ear changes with absent organs of Corti, rupture and collapse of Reissner's membrane, strial degeneration, and a decreased spiral ganglion cell population. The occurrence of inner-ear trauma with an intact tympanic membrane and normal middle-ear structures suggests that a mechanism other than blast injury was responsible for the pathologic changes in this case.
A boy, injured by lightning, had cardiopulmonary arrest. Following resuscitation and during the course of hospitalization, he developed further cardiac arrhythmia, cerebral edema, generalized seizures, and upper gastrointestinal bleeding. Despite efforts to combat these complications, the patient's condition deteriorated, and he died on the tenth day of hospitalization. The pathologic findings are described and the treatment discussed.