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Mass casualties and triage at a sporting event.

When a sports medicine doctor provides coverage for a sporting event with a large number of athletes and spectators, he or she should always be aware that the potential for a large number of injuries exists. In the event of a mass casualty incident that overwhelms the available medical resources, he or she may be the most qualified professional present to triage and organise patient care. Certain basic rules of triage in a disaster situation should be followed, the goal being to save as many lives as possible. Special circumstances, such as crush injuries, lightning strikes, and blast injuries, may affect the triage and initial care of injured patients.

Blast Injuries↗

Emergent care of lightning and electrical injuries.

High-voltage electrical injuries may be devastating, with extensive burns, cardiac arrest, amputations, and long, complicated hospitalizations. Low-voltage injuries, after other pathologic and high-voltage sources are ruled out, tend to be rather benign acutely although they may have significant long-term morbidity, including chronic pain syndromes. Lightning injuries affect 800 to 1000 persons per year. In lightning injury, cardiac arrest is the main cause of death, burns tend to be superficial, ad injuries often are what one would expect of short-circuiting or overloading the body's electrical systems (tinnitus, blindness, confusion, amnesia, cardiac arrhythmias, and vascular instability). Although high-voltage injuries may require the services of trauma surgeons, in general, therapy for low-voltage and lightning injury is supportive and involves cardiac resuscitation for the more seriously injured and supportive care for the less severely injured. Long-term problems from sleep disturbances, anxiety attacks, pain syndromes, peripheral nerve damage, fear of storms (for lightning patients), and diffuse neurologic and neuropsychologic damage may occur in both electrical and lightning patients. Other sequelae--such as seizures or severe brain damage from hypoxia during cardiac arrest and spinal artery syndrome from vascular spasm--are indirect results of electrical and lightning injury.

Clinical Laboratory Techniques↗

Neuro-otologic findings in the lightning-injured patient.

Although lightning injuries are common, neuro-otologic sequelae are infrequently reported. The most common otologic injury encountered in the lightning strike victim is tympanic membrane rupture; the most common vestibular disturbance documented is transient vertigo. A variety of other clinical findings have been described in this population of patients. They include sensorineural hearing loss, conductive deafness, tinnitus, basilar skull fracture, avulsion of the mastoid bone, burns to the external auditory canal, and peripheral facial nerve palsy. The initial treatment of the lightning strike victim consists of basic life support measures. Once stabilized, the patient should undergo a complete otologic and vestibular evaluation. The majority of otolaryngologic problems encountered can be managed expectantly, with periodic re-evaluation. Tympanoplasty should be delayed for 6 to 12 months because of the frequent delay in spontaneous healing.

Ear Canal↗

Environmental injuries.

Environmental injuries and illnesses can happen in home, work, or recreational settings. The variety and severity of these injuries might require the clinician to call on skills from internal medicine, emergency medicine, and toxicology. Diseases of thermoregulation are hypothermia and hyperthermia. In each instance, treatment is based on the need to restore the patient's core temperature to normal and on monitoring for complications. The victim of a fire might suffer inhalation injury in addition to burns, and it is more likely that the inhalation injury will be fatal. Oxygen deprivation and inhalation of irritant or asphyxiant chemicals contribute to injury. Toxic plants can be the source of poisoning emergencies, especially in children. Misinformation and myths that surround common plants can create diagnostic problems (i.e., which plants really are toxic and require emergency measures). Venomous marine organisms can cause a wide range of injury, from cutaneous eruption to fatal envenomation. Most are encountered in a recreational setting, such as water sports, but keepers of home aquariums are subject to stings from venomous fish. Lightning injury can present many diagnostic and treatment dilemmas. An important point in this regard is that lightning injury and high-voltage electrical injury are different in pathology and require different approaches for treatment. A discussion of electrical, chemical, and thermal burns makes such differences apparent.

Burns↗

Physeal injury in a lightning strike survivor.

Electrical injuries resulting in physeal injury in children are an uncommon but well-recognized clinical entity. Almost all these injuries are sustained from man-made electrical sources. To date, there have been no published cases of growth arrest after lightning strike. The authors report the case of a 12-year-old girl who survived a lightning strike 2 years ago and who presented with asymmetric growth arrest in both legs. The authors discuss the pathophysiology of lightning strike and consider the evidence for direct electrical injury versus ischemic insult to the physis as explanations for the cause of the growth arrest observed in this patient.

Child↗

Nature's high-voltage injuries: sometimes a deadly consequence.

A patient is described who presented with the clinical picture of respiratory failure, persistent comatose state and myocardial injury after being struck by lightning. The discussion reviews the management of lightning injuries with emphasis on cardiovascular and neurological complications.

Adult↗

Lightning and electrical injuries: neuro-ophthalmologic aspects.

Lightning and electrical injuries have widespread manifestations involving almost all organ systems of the body, including the central nervous system (CNS) and the eye. This article considers the neuro-ophthalmologic effects of lightning and electrical injury.

Animals↗

An unusual case of lightning strike: full-thickness burns of the cranial bones.

An unusual full-thickness burn of the scalp and cranial bones due to a lightning strike is reported. A thick nylon cover protected the head from the direct effects of the lightning injury, but heated water over the thick nylon cover caused full-thickness burn of the scalp and cranial bones. The relevant literature has been reviewed.

Adult↗