Unusual resuscitation situations: environmental emergencies.
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Individuals who are outdoors during thunderstorms are at risk for death from direct and indirect lightning hits. Death is more likely from 3:00 p.m. to 8:00 p.m. during the months of May through September. The fatality pattern in North Carolina is similar to that reported for the nation as a whole. Physicians are urged to discuss with their patients simple strategies for reducing exposure to lightning.
It is reported on deaths of pigs due to lightning stroke in the barn. During a severe thunder storm 11 clinically healthy pigs with an average weight of approx. 22 kg died simultaneously and suddenly in the barn. The animals were kept on a floor of metal slats. The pens were separated by metal bars. A water pipe leading into the barn from outside had contact to the bars. Two pigs were submitted for an examination approx. three hours post mortem. The macroscopic and microscopic necropsy findings are described.
Intra-cerebral haemorrhage due to lightning stroke is extremely rare. We report a 45 year old woman who developed intracranial haemorrhage due to a direct lightning stroke. This was proved by CT scan. The haematoma was evacuated surgically, resulting in full neurological recovery of the patient.
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Lightning is a significant cause of mortality in Zimbabwe. The same study showed that 21 per cent of fatal lightning strikes occurred with victims inside a hut. We report a case who survived a severe lightning strike with unusual features of a temporary bulbar palsy.
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Two men with recent history of lightining strike were referred to our hospital. Both patients complained of metamorphosia in one eye and reduced visual acuity. Funduscopy revealed target-like alterations at the fovea. Fluorescein angiography showed window defects of the central retinal pigment epithelium in both patients. One patient developed an anterior subcapsular cataract. If the eye is part of the current-circuit, the melanin granules of the iris, pigment epithelium, and choroid might act as a resistor. The resulting accumulation of heat may lead to damage of the surrounding tissues.
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Andersen Air Force Base in Guam boasts the tallest control tower in the Air Force. In 1986, an air traffic controller was struck by lightning as the bolt proceeded through the tower. Although he received only a backache, the lightning left a hole with surrounding scorch marks on his fatigue shirt and his undershirt. The lightning strike also ignited a portion of the field lighting panel, which caused the runway lights to go out immediately. Lack of a lightning rod is the most likely reason the controller was struck. Proper precautions against lightning strikes can prevent such occupational safety hazards.
BACKGROUND: Lightning can cause a number of ocular complications. A case involving a patient who developed a cataract and reversible maculopathy in both eyes after being struck by lightning is reported. METHODS: The patient was evaluated for cataract and macular edema by ophthalmoscopic examination, fluorescein angiography, and potential acuity meter. RESULTS: Maculopathy developed that was characterized initially by a retinal cyst with surrounding edema. Later, the lesions evolved to simulate a full-thickness hole. These lesions subsequently resolved, and the patient's visual acuity improved to 20/20 in each eye after cataract extraction. CONCLUSION: Because the visual prognosis for lightning-induced maculopathy is potentially different than that for full-thickness macular holes, careful retinal examination is essential in the preoperative workup.
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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.