Lightning injuries

Lightning is persistently one of the leading causes of death caused by environmental or natural disaster. To understand the pathophysiology and treatment of lightning injuries one must first discount the innumerable myths, superstitions, and misconceptions surrounding lightning. The fundamental difference between high voltage electrical injury and lightning is the duration of exposure to current. Reverse triage should be instituted in lightning strike victims because victims in cardiopulmonary arrest might gain the greatest benefit from resuscitation efforts, although there is no good evidence suggesting that lightning strike victims might benefit from longer than usual resuscitation times. Many of the injuries suffered by lightning strike victims are unique to lightning, and long-term sequelae should be anticipated and addressed in the lightning victim.     

Lightning strike: an unusual etiology of gastric perforation

Lightning strike is an unusual form of trauma in terms of being one of the leading causes of death from natural phenomenon. Lightning strike can cause severe damage to many systems and results in a high mortality. The most common cause of death in the lightning strike victim is cardiopulmonary arrest. The most vulnerable subjects for lightning strike are individuals who work in open fields, farmers, and swimmers. The cardiac and neurological injuries are the most serious injuries. Burns, tinnitus, blindness, and secondary blunt trauma have also been reported. Gastrointestinal complications have been documented very rarely. In this study, we present a case of gastric perforation after lightning strike. No report related to gastric perforation caused by lightning strike has been identified in the literature.     

Electrical and lightning injuries

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.     

High voltage electrical injuries in the University of Calabar Teaching Hospital

BACKGROUND: Burn injuries are a common presentation in Nigerian hospitals and result from a variety of causes. Recently, many have resulted from Petroleum related fire incidents. High voltage electrical injuries are relatively rare; lightning strikes even rarer. In traditional societies where Traditional medicine practitioners are usually the first to be contacted and where late presentation to hospitals is the rule, complications such as the wet gangrene necessitating amputation are common. Even when patients present relatively early and are resuscitated and treated, complete prosthetic rehabilitation is difficult because of poverty and lack of social support systems. CASE REPORT: This review presents three cases of high voltage electrical burns resulting from typical 11KVA burns as well as lightning strike. It also highlights the role of prompt presentation in a health facility with appropriate resuscitation in determining good treatment outcomes.     

Lightning injuries

Lightning strikes may cause a constellation of injuries. Blunt head trauma, neurologic injury, and cardiac injury are common in these patients. In contrast to high-voltage electrocutions, blunt trauma after a lightning strike is common. Thorough evaluation of all organ systems is crucial. This report discusses mechanism of injury and describes initial evaluation and treatment of lightning strike victims.     

Childhood lightning injuries on the playing field

Two young boys were struck by lightning during summer outdoor activities. One of them died. A literature review reveals that the most commonly reported locations of childhood lightning injuries are on the playing field, at the swimming pool, and in tents. Knowledge of measures to lower the risks of lightning strikes as well as the use of new lightning detection technology should help to reduce the numbers of these tragic events in the future.     

Electrical injuries and lightning.

Prolonged cardiopulmonary resuscitation is key to the resuscitation of lightning strike victims. Multiple accounts exist of successful revival of victims thought to be "dead" or in patients who have what is often believed to be unresuscitatable cardiac dysrhythmia. Victims of lightning injury may, in addition to their electrical injury, have secondary injuries that require expedient care if significant morbidity is to be avoided. They should be treated as any victim of trauma, that is, with a complete and thorough evaluation including hospitalization if warranted. In the absence of a cardiac arrest or serious secondary injury, care for the lightning strike victim is generally supportive in nature.     

The evaluation and management of electrical injuries

It is essential for the critical care physician to understand the ramifications of electrical injuries, as these patients are frequently seen in the ICU. Being able to anticipate possible complications may be ultimately life-preserving. A collaborative effort between the surgeon, critical care physician, and ICU staff ensures premium care for this injured patient. Educational efforts for the public regarding precautions in the avoidance of electrical and lightning injuries will help prevent many of these accidents.     

A Fifth Mechanism of Lightning Injury

The four classic electrical mechanisms of lightning injury cannot account for all injuries. A fifth mechanism, injury by a weak upward streamer that does not become part of a completed lightning channel, has long been postulated in the engineering literature by lightning researchers. This paper reports a case of death where injury from a weak upward streamer is strongly suspected following forensic investigation. Neither high voltage nor any of the previously accepted mechanisms of lightning injury can explain this incident.     

Lightning, sudden cardiac death, simulation and an automated external defibrillator: the perfect storm

This is a report of an 11-year-old boy who had sudden cardiac death after a lightning strike while playing lacrosse at summer camp. The camp staff had performed weekly drills to prepare for various medical emergencies and quickly activated their "Emergency Activation System". The child received immediate cardiopulmonary resuscitation (CPR) and was defibrillated with an automated defibrillator (AED) within 3 min of becoming pulseless and was ultimately resuscitated after being defibrillated three times. A community ambulance with a defibrillator on board did not arrive until several minutes after the on-site team had achieved return of spontaneous circulation. In this report, we describe the clinical course of this patient; briefly review lightning injuries, other causes of sudden cardiac death in children and use of AEDs. Finally, we review how simulation has been used in this case and others as a mechanism to ensure preparedness for medical emergencies. This child is alive and well today because of these well-trained camp counselors. Their system of using simulation to maintain emergency readiness serves as an example for lay and professional medical providers alike.     

EPIDEMIOLOGY,MORBIDITY, MORTALITY AND TREATMENT OF LIGHTNING INJURIES IN A TURKISH BURNS UNITS

Deaths from lightning injuries are infrequent – 0.2–0.8 per million per year. The victims are mostly young, active people who are struck during various outdoor activities in the summer months. From November 1975 to October 1998; 22 lightning burns were treated in Ankara Numune Teaching and Research Hospital. The mean age of the patients was 32.9 (12–65) years, the female/male ratio 9/13 and the mean duration of hospital stay 15.4 (1–62) days. The commonest clinical symptoms were confusion, amnesia (5 patients), neurological dysfunction (2 patients), cystitis (4 patients), and cardiac arrhythmias (1 patient). There were no deaths. Sixteen surgical procedures were carried out on 14 patients; this was significantly fewer than from any other cause of burns. The commonest long-term complication was chronic pain. Because complications are frequently seen in lightning injuries, our results revealed that patients should be hospitalised and treated as soon as possible after the accident with fluid resuscitation, cardiac resuscitation, tetanus prophylaxis and antibiotics where necessary.     

Evaluation and treatment of trauma related collapse in athletes

Although blunt traumatic injuries are common in athletes, life-threatening trauma is fortunately rare. Most current literature has focused on nontraumatic causes of athlete death though traumatic injuries may be more common. Although prevention of these injuries may be more difficult than nontraumatic causes, prompt recognition and treatment is paramount. Common traumatic causes of collapse athlete generally involve the head, neck, and trunk and are more frequent in collision sports. Other higher risk sports include track and field, cheerleading, snow sports, and those involving motorized vehicles. Health care providers who participate in sports coverage should be aware of the potential for these injuries as emergency treatment is required to maximize outcomes. Emergency action plans allow providers to expediently activate emergency management services while providing treatment and stabilization.     

Electrical injuries: a 20-year review

Electrical injuries continue to present problems with devastating complications and long-term socioeconomic impact. The purpose of this study is to review one institution's experience with electrical injuries. From 1982 to 2002, there were 700 electric injury admissions. A computerized burn registry was used for data collection and analysis. Of these injuries, 263 were high voltage (> or =1000 V), 143 were low voltage (<1000 V), 277 were electric arc flash burns, and 17 were lightning injuries. Mortality was highest in the lightning strikes (17.6%) compared with the high voltage (5.3%) and low voltage (2.8%) injuries, and mortality was least in electric arc injuries without passage of current through the patient (1.1%). Complications were most common in the high-voltage group. Mean length of stay was longest in this group (18.9 +/- 1.4 days), and the patients in this group also required the most operations (3 +/- 0.2). Work-related activity was responsible for the majority of these high-voltage injuries, with the most common occupations being linemen and electricians. These patients tended to be younger men in the prime of their working lives. Electrical injuries continue to make up an important subgroup of patients admitted to burn centers. High-voltage injuries in particular have far reaching social and economic impact largely because of the patient population at greatest risk, that is, younger men at the height of their earning potential. Injury prevention, although appropriate, remains difficult in this group because of occupation-related risk.     

Takotsubo cardiomyopathy following lightning strike

Lightning strike is the most common environmental cause of sudden cardiac death, but may also be associated with a myriad of injuries to various organ systems. Direct myocardial injury may be manifest as electrocardiographic alterations or elevation in cardiac-specific isoenzymes; however, significant electrical cardiac trauma appears uncommon. A case is presented of severe acute cardiomyopathy in a "Takotsubo" distribution causing cardiogenic shock following lightning strike in a previously healthy 37-year-old woman. Although rarely identified in this context, Takotsubo cardiomyopathy (also known as "transient left ventricular apical ballooning syndrome") is characterised by transient cardiac dysfunction, electrocardiographic changes that may mimic acute myocardial infarction and minimal release of cardiac-specific enzymes in the absence of obstructive coronary artery disease. The condition is associated with a substantial female bias (up to 90% of cases) in reported series, and despite occasionally dramatic presentations recovery of left ventricular function is almost universal over days to weeks. In rare instances, however, the syndrome has been associated with more catastrophic complications such as papillary muscle or cardiac free wall rupture, necessitating emergency surgical intervention to preserve life. In clinical practice, non-lethal lightning strike-induced cardiac injury is frequently associated with small elevations of cardiac isoenzymes without overt clinical sequelae; however, the incidence of silent myocardial mechanical dysfunction remains unknown. Cases such as the one presented highlight the potential for serious, albeit usually transient, cardiac sequelae from lightning strike injury and remind us that our mothers' advice to remain indoors during thunderstorms is probably worth heeding.     

Groin injuries and groin pain in athletes: part 2

Sports injuries to the hip and groin region have been noted in 5% to 9% of high school athletes. These injuries occur most commonly in athletes participating in sports involving side-to-side cutting, quick accelerations and decelerations, and sudden directional changes.Symptoms may range from intermittent episodes of mild discomfort to severe and chronic career-ending pain. Groin injuries may result from a variety of causes. Although this article deals mainly with athletic etiologies, the physician must keep in mind that many other medical conditions may also affect the groin. Because of these overlapping medical conditions and because the anatomy of the region is so complex, a team approach is optimal. In the second of this two-part series, disorders of the os pubis, stress fractures and various hip pathologies are reviewed as causes of groin pain.     

Groin injuries and groin pain in athletes: part 1

Sports injuries to the hip and groin region have been noted in 5% to 9% of high school athletes. These injuries occur most commonly in athletes participating in sports involving side-to-side cutting, quick accelerations and decelerations, and sudden directional changes.Symptoms may range from intermittent episodes of mild discomfort to severe and chronic career-ending pain. Groin injuries may result from a variety of causes. Although this article deals mainly with athletic etiologies, the physician must keep in mind that many other medical conditions may also affect the groin. Because of these overlapping medical conditions and because the anatomy of the region is so complex, a team approach is optimal. In Part 1 of this two-part series, ligament/muscle strains, nerve entrapment syndromes, and posterior abdominal wall abnormalities are reviewed as common causes of groin pain.     

Second-impact syndrome.

Sports-related injuries are among the more common causes of injury in adolescents that can result in concussion and its sequelae, postconcussion syndrome and second-impact syndrome (SIS). Students who experience multiple brain injuries within a short period of time (hours, days, or weeks) may suffer catastrophic or fatal reactions related to SIS. Adolescents are particularly susceptible to the dangers of SIS, and current return-to-play guidelines may be too lenient to protect a student from SIS. Any student with signs of a concussion should receive medical evaluation and not be allowed to return to play in the current game or practice. The role of the school nurse includes being knowledgeable about management of head injuries and return-to-play guidelines, providing follow-up for athletes who have concussions, and providing education on prevention and management of head injuries.     

Prolonged disability from job-related injury

Workers who do not recover as expected from job-related injuries are frequently disabled not by organic complications of their injuries but by a problem that the patient may not acknowledge and the physician may not recognize and deal with. The family physician should be skilled in detecting nonorganic causes of disability and in intervening appropriately to maintain a therapeutic relationship between the patient and the health care providers.     

Lightning injuries

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.     

Etiology, prevention, and early intervention of overuse injuries in runners: a biomechanical perspective

Overuse running injuries occur frequently, and generally could be said to occur as a result of a runner maintaining a stress/frequency combination which puts a vulnerable musculoskeletal structure within the injury portion of a stress-frequency relationship. Given a runner's specific anthropometric and biomechanical stride characteristics, the causes of all overuse running injuries could be classified as training errors, and thus, all overuse running injuries should be preventable. One of the goals of future research should be to focus on developing simple screening processes that may assist medical practitioners in identifying runners who are at a high risk for overuse injury.