ABSTRACT
BACKGROUND: There is a limited evidence base to inform patient management following lightning-induced injuries. CASE REPORT: A 36-year-old right-handed Caucasian male struck by lightning while outdoors suffered an out-of-hospital cardiac arrest with a recorded 50-min interval before the restoration of spontaneous circulation. Multiple life threatening injuries were sustained and a profound peripheral neuropathy developed. Cognitively, he was remarkably intact. We document his acute admission and his recovery during an inpatient stay in a UK-based Neurorehabilitation Unit. CONCLUSION: Intensive neurorehabilitation in this case improved functional independence and facilitated neuropsychological recovery, to the point that our patient was discharged to independent living. This case offers some support to the hypothesis that the electrical activity of a lightning strike can be both cardioprotective and neuroprotective, and that prolonged cardiopulmonary resuscitation is warranted in such cases.
Subject(s)
Critical Care/methods , Lightning Injuries/complications , Lightning Injuries/rehabilitation , Neurological Rehabilitation , Out-of-Hospital Cardiac Arrest/etiology , Out-of-Hospital Cardiac Arrest/rehabilitation , Survivors/psychology , Adult , Cardiopulmonary Resuscitation , Cognitive Behavioral Therapy , Humans , Lightning Injuries/physiopathology , Lightning Injuries/therapy , Male , Neurological Rehabilitation/methods , Out-of-Hospital Cardiac Arrest/physiopathology , Out-of-Hospital Cardiac Arrest/therapy , Recovery of Function , Stress Disorders, Post-Traumatic/diagnosis , Time Factors , Treatment OutcomeABSTRACT
Lightning strikes cause severe injuries and fatalities. Injuries vary from self-limiting skin manifestations to cardiac arrest and death. Because the event is sudden and unpredictable, assessment of the direct effects of the lightning on the human heart is usually impossible. In this case, a 16-year old boy who had an implanted loop recorder subcutaneous cardiac monitor was hit by lightning during a picnic and survived. A cardiac rhythm strip was recorded live during the strike. SIMILAR CASES PUBLISHED: 0.
Subject(s)
Electrodes, Implanted , Lightning Injuries/physiopathology , Adolescent , Humans , MaleABSTRACT
BACKGROUND: Lightning strike is a rare medical emergency. The primary cause of death in lightning strike victims is immediate cardiac arrest. The mortality rate from lightning exposure can be as high as 30%, with up to 70% of patients left with significant morbidity. CASE REPORT: An 86-year-old male was struck by lightning while driving his vehicle and crashed. On initial emergency medical services evaluation, he was asymptomatic with normal vital signs. During his transport, he lost consciousness several times and was found to be in atrial fibrillation with intermittent runs of ventricular tachycardia during the unconscious periods. In the emergency department, atrial fibrillation persisted and he experienced additional episodes of ventricular tachycardia. He was treated with i.v. amiodarone and admitted to cardiovascular intensive care unit, where he converted to a normal sinus rhythm on the amiodarone drip. He was discharged home without rhythm-control medications and did not have further episodes of dysrhythmias on follow-up visits. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Lightning strikes are one of the most common injuries suffered from natural phenomenon, and short-term mortality ordinarily depends on the cardiac effects. This case demonstrates that the cardiac effects can be multiple, delayed, and recurrent, which compels the emergency physician to be vigilant in the initial evaluation and ongoing observation of patients with lightning injuries.
Subject(s)
Atrial Fibrillation/etiology , Lightning Injuries/complications , Lightning Injuries/physiopathology , Tachycardia, Ventricular/etiology , Aged, 80 and over , Amiodarone/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Electrocardiography/methods , Emergency Service, Hospital/organization & administration , Humans , Lightning , Male , Motor VehiclesABSTRACT
Lightning strikes rarely occur but 85 % of patients have lightning-related neurological complications. This report provides an overview about different modes of energy transfer and neurological conditions related to lightning strikes. Moreover, two case reports demonstrate the importance of interdisciplinary treatment and the spectrum of neurological complications after lightning strikes.
Subject(s)
Lightning Injuries/complications , Lightning Injuries/diagnosis , Nervous System Diseases/diagnosis , Nervous System Diseases/etiology , Brain/physiopathology , Brain Damage, Chronic/diagnosis , Brain Damage, Chronic/etiology , Brain Damage, Chronic/physiopathology , Brain Damage, Chronic/therapy , Brain Edema/complications , Brain Edema/diagnosis , Brain Edema/physiopathology , Brain Edema/therapy , Critical Care/methods , Fatal Outcome , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/etiology , Guillain-Barre Syndrome/physiopathology , Guillain-Barre Syndrome/therapy , Humans , Interdisciplinary Communication , Intersectoral Collaboration , Lightning Injuries/physiopathology , Lightning Injuries/therapy , Male , Multiple Trauma/diagnosis , Multiple Trauma/therapy , Nervous System Diseases/physiopathology , Nervous System Diseases/therapy , Prognosis , Tomography, X-Ray Computed , Young AdultABSTRACT
Direct lightning strikes to human heads lead to various effects ranging from Lichtenberg figures, over loss of consciousness to death. The evolution of the induced current distribution in the head is of great interest to understand the effect mechanisms. This work describes a technique to model a simplified head-phantom to investigate effects during direct lightning strike. The head-phantom geometry, conductive and dielectric parameters were chosen similar to that of a human head. Three layers (brain, skull, and scalp) were created for the phantom using agarose hydrogel doped with sodium chloride and carbon. The head-phantom was tested on two different impulse generators, which reproduce approximate lightning impulses. The effective current and the current distribution in each layer were analyzed. The biggest part of the current flowed through the brain layer, approx. 70 % in cases without external flashover. Approx. 23 % of the current flowed through skull layer and 6 % through the scalp layer. However, the current decreased within the head-phantom to almost zero after a complete flashover on the phantom occurred. The flashover formed faster with a higher impulse current level. Exposition time of current through the head decreases with a higher current level of the lightning impulse. This mechanism might explain the fact that people can survive a lightning strike. The experiments help to understand lightning effects on humans.
Subject(s)
Lightning Injuries/physiopathology , Phantoms, Imaging , Brain , Electrodes , Equipment Design , Humans , Hydrogels , Scalp/injuries , Skull/injuries , Sodium ChlorideABSTRACT
OBJECTIVE: This study describes a case of lesions of the upper motor neuronal pathway with locked-in features after lightning strike and cardiac arrest. DESIGN: A case-review analysis. METHODS: In a 29-year-old male who was hit by a lightning strike during farming activities, cardiopulmonary resuscitation was provided first by co-workers and continued with success by the medical rescue service. After conducting advanced life support under monitoring and therapeutic hypothermia, quadriplegia with facial diplegia was recognized. A review was undertaken detailing the clinical course. RESULTS: MR imaging presented signs consistent with hypoxia-induced damage and diffusion-weighted MR images revealed pronounced damages along the upper motor neuronal pathway. A reactive electroencephalogram pattern, sustained eye movement and the patient communicating via eye-blinking were interpreted as locked-in features. Two weeks after admission the patient was transferred to a neurological rehabilitation centre for further professional care. CONCLUSION: Direct damage of the upper motor neuron pathway due to the current of the lightning should be considered, albeit the relative contribution of hypoxia-induced damage cannot be separated.
Subject(s)
Cardiopulmonary Resuscitation/methods , Heart Arrest/physiopathology , Hypothermia, Induced/methods , Hypoxia, Brain/physiopathology , Lightning Injuries/physiopathology , Neural Pathways/physiopathology , Quadriplegia/physiopathology , Adult , Heart Arrest/etiology , Heart Arrest/rehabilitation , Humans , Hypoxia, Brain/complications , Lightning Injuries/complications , Lightning Injuries/rehabilitation , Magnetic Resonance Imaging , Male , Neural Pathways/injuries , Quadriplegia/etiology , Quadriplegia/rehabilitation , Recovery of Function , Time FactorsABSTRACT
Electrical injuries, while uncommon, can be associated with significant morbidity and mortality. In children, the injuries tend to occur in the household; in adolescents, they are most often associated with misguided youthful exploration outside the home. Injuries in adults are primarily occupational and due to workplace accidents. Electrical injuries are categorized by their electrical source and can result from low-voltage, high-voltage, lightning strike, or electrical arc exposure. The injury can range from minor to life threatening, and they can cause multisystem complications. High-voltage electrical exposures usually cause severe burns, whereas victims of lightning strikes may have no obvious physical injury but may present in cardiopulmonary arrest. Strategies to prevent electrical injuries have been developed and should be discussed with families and healthcare providers to reduce the incidence of these injuries in children. This review highlights the current literature related to the evaluation and management of children with electrical injuries presenting to the emergency department.
Subject(s)
Accident Prevention/methods , Burns, Electric , Emergency Treatment , Lightning Injuries , Multiple Organ Failure/etiology , Triage , Adolescent , Burns, Electric/complications , Burns, Electric/diagnosis , Burns, Electric/physiopathology , Burns, Electric/therapy , Caregivers/education , Child , Electricity/adverse effects , Emergency Treatment/methods , Emergency Treatment/standards , Evidence-Based Emergency Medicine , Humans , Lightning Injuries/complications , Lightning Injuries/diagnosis , Lightning Injuries/physiopathology , Lightning Injuries/therapy , Multiple Organ Failure/diagnosis , Multiple Organ Failure/physiopathology , Multiple Organ Failure/therapy , Multiple Trauma/complications , Multiple Trauma/diagnosis , Multiple Trauma/physiopathology , Multiple Trauma/therapy , Practice Guidelines as Topic , Trauma Severity Indices , Treatment Outcome , Triage/methods , Triage/standardsABSTRACT
OBJECTIVE: To describe and review autonomic complications of lightning strike. METHODS: Case report and laboratory data including autonomic function tests in a subject who was struck by lightning. RESULTS: A 24-year-old man was struck by lightning. Following that, he developed dysautonomia, with persistent inappropriate sinus tachycardia and autonomic storms, as well as posttraumatic stress disorder (PTSD) and functional neurologic problems. INTERPRETATION: The combination of persistent sinus tachycardia and episodic exacerbations associated with hypertension, diaphoresis, and agitation was highly suggestive of a central hyperadrenergic state with superimposed autonomic storms. Whether the additional PTSD and functional neurologic deficits were due to a direct effect of the lightning strike on the central nervous system or a secondary response is open to speculation.
Subject(s)
Autonomic Nervous System Diseases/etiology , Lightning Injuries/complications , Activities of Daily Living , Adrenergic alpha-Agonists/therapeutic use , Anxiety/etiology , Arrhythmias, Cardiac/etiology , Autonomic Nervous System Diseases/physiopathology , Autonomic Nervous System Diseases/psychology , Burns/etiology , Burns/pathology , Case Management , Clonidine/therapeutic use , Humans , Lightning Injuries/physiopathology , Lightning Injuries/psychology , Male , Neurologic Examination , Pain/etiology , Primary Dysautonomias/etiology , Psychomotor Agitation/etiology , Recovery of Function , Sleep Initiation and Maintenance Disorders/etiology , Stress Disorders, Post-Traumatic/complications , Stress Disorders, Post-Traumatic/physiopathology , Treatment Failure , Young AdultSubject(s)
Atrial Fibrillation/etiology , Electrocardiography , Heart Conduction System/physiopathology , Heart Rate/physiology , Lightning Injuries/complications , Pre-Excitation Syndromes/etiology , Adult , Atrial Fibrillation/psychology , Atrial Fibrillation/surgery , Catheter Ablation , Follow-Up Studies , Heart Conduction System/surgery , Humans , Lightning Injuries/physiopathology , Male , Pre-Excitation Syndromes/physiopathology , Pre-Excitation Syndromes/surgeryABSTRACT
Los fenómenos de despolarización cortical propagada (CSD y CSD-like) son despolarizaciones celulares que se extienden en forma de onda y están implicados en la progresión de las lesiones en pacientes con ictus y traumatismo craneoencefálico (TCE). Son detectables en el registro de electrocorticografía (ECoG). Experimentalmente inducen hipoxia cerebral e incrementa la permeabilidad de la barrera hematoencefálica. Objetivos: Determinar la frecuencia y duración de estos episodios en pacientes con TCE o infarto maligno de la arteria cerebral media (IMACM) que requieran craniectomía. Material y métodos: 20 pacientes a los que se les colocó, en el córtex perilesional, una tira de seis electrodos. Análisis del número y la duración de los episodios de CSD registrados. Resultados: En cuatro, de los ocho registros de ECoG analizados, se identificaron episodios de CSD o CSD-like de duración y frecuencia variable. Conclusiones: Se detectan frecuentemente episodios de CSD y CSD-like en pacientes con IMACM y TCE (AU)
The phenomena of cortical spreading depolarization (CSD and CSD-like phenomena) are cellular depolarization waves involved in the progression of lesions in patients with stroke and traumatic brain injury (TBI). Which are detected by an electrocorticographic (ECoG) recording. Experimentally, CSD induces cerebral hypoxia and increases the permeability of the blood-brain barrier. Objectives: To determine the frequency and duration of CSD episodes in patients with TBI and malignant middle cerebral artery infarction (MMCAI) requiring craniectomy. Material and methods: 20 patients were included. A strip of 6 electrodes was placed in the perilesional cortex. Analysis of the number and duration of CSD episodes in the ECoG recording was performed. Results: In four, of the eight ECoG recordings that was fully analyzed, CSD or CSD-like phenomena were identified with a variable frequency and duration. Conclusions: Episodes of CSD and CSD-like phenomena are frequently detected in patients with MMCAI and TBI (AU)
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Adult , Middle Aged , Intracranial Arterial Diseases/complications , Intracranial Arterial Diseases/physiopathology , Intracranial Arterial Diseases/therapy , Storms/adverse effects , Electrodes , Head Injuries, Penetrating/complications , Head Injuries, Penetrating/rehabilitation , Pilot Projects , Lightning Injuries/complications , Lightning Injuries/physiopathology , Head Injuries, Penetrating/physiopathology , Head Injuries, Penetrating/radiotherapy , Head Injuries, Penetrating , Glasgow Outcome ScaleABSTRACT
Several case reports have presented various neurological complications caused by lightning. However, there was no report related to cerebral salt wasting caused by lightning injury. We described a patient with lightning strike, who was subsequently diagnosed with cerebral salt wasting.
Subject(s)
Brain/physiopathology , Lightning Injuries/complications , Lightning Injuries/physiopathology , Child , Female , Glasgow Coma Scale , Humans , Hyponatremia/etiology , Water-Electrolyte Imbalance/etiologyABSTRACT
Electrical injuries to the extremity can result in significant local tissue damage and systemic problems. An understanding of the pathophysiology of electrical injuries is critical to the medical and surgical management of patients who sustain these injuries.
Subject(s)
Electric Injuries/diagnosis , Electric Injuries/therapy , Burns, Electric/diagnosis , Burns, Electric/physiopathology , Burns, Electric/therapy , Compartment Syndromes/prevention & control , Decompression, Surgical , Electric Injuries/physiopathology , Electrocardiography , Fluid Therapy , Humans , Lightning Injuries/complications , Lightning Injuries/physiopathology , Lightning Injuries/therapy , Skin TransplantationSubject(s)
Electrocardiography , Heart Arrest/diagnosis , Lightning Injuries/diagnosis , Pulmonary Edema/diagnosis , Adult , Cardiopulmonary Resuscitation , Heart Arrest/physiopathology , Heart Arrest/therapy , Humans , Hydrostatic Pressure , Lightning Injuries/physiopathology , Lightning Injuries/therapy , Male , Pulmonary Edema/physiopathology , Pulmonary Edema/therapy , Radiography, ThoracicABSTRACT
MYTH: There's no danger from lightning until the rain starts. FACT: Lightning often precedes the storm by up to 10 miles. A reasonable guideline is the "30-30 rule," by which you count the seconds between the flash and the thunder. If the time span is less than 30 seconds, seek shelter. Additionally, wait a full 30 minutes from last lightning flash to resume outdoor activities.
Subject(s)
Emergency Medical Services/methods , Lightning Injuries/physiopathology , Humans , Lightning Injuries/therapyABSTRACT
It is estimated that a lightning flash occurs approximately 8 million times per day throughout the world. Most strikes are benign and cause little damage to property and physical structures; however, when lightning strikes a person or group of people, it is a significant medical and potentially traumatic event that could lead to immediate death or permanent disability. By understanding some basic physics of lightning and pathophysiology of injuries associated with lightning strikes, EMS providers will be better prepared to identify assessment findings, anticipate complications and provide effective emergency care.
Subject(s)
Emergency Medical Technicians/education , Emergency Treatment/methods , Lightning Injuries/physiopathology , Lightning Injuries/therapy , Burns, Electric/etiology , Central Nervous System Diseases/etiology , Education, Medical, Continuing , Heart Arrest/etiology , Humans , Lightning , Occupational Health , Physical Phenomena , Physics , Risk , Triage , Wounds, Nonpenetrating/etiologySubject(s)
Heart/physiopathology , Lightning Injuries/diagnosis , Lightning , Adult , Electrocardiography , Humans , India , Lightning Injuries/physiopathology , MaleABSTRACT
Atrial fibrillation (AF) is a common arrhythmia that occurs in paroxysmal and persistent forms. It occurs in varied situations but lightning induced AF is extremely rare. Here is a case which reverted to sinus rhythm spontaneously. This 37-year-old man without any underlying heart disease had new onset AF after being struck by a lightning. Oral Metoprolol alone was given to control ventricular rate. Spontaneous reversion to sinus rhythm within 36 hours is in favor of new onset lightning induced AF.
