Lightning Injury

Types of human lightning strikes

Lightning may injure an individual in 6 ways.^{[5, 32, 33, 34]}

• Direct strike (approximately 3-5% of injuries)
• Side splash from another object (approximately 30% of injuries)
• Contact voltage from touching an object that is struck (approximately 1-2% of injuries)
• Ground current effect as the energy spreads out across the surface of the earth when lightning hits a distance away from the person (approximately 40-50% of injuries)
• Upward leader that does not connect with the downward leader to complete a lightning channel (approximately 20-25% of injuries)
• Blunt trauma if a person is thrown and barotrauma from being close enough to experience the explosive force of lightning^[31]
  
  
  
  

  Complications

  Although rare, serious lightning injuries are likely to primarily cause cardiac and neurologic injury.^{[15, 16, 17]} Otologic injury and cutaneous burns have also been noted as frequent sequelae of these events.^{[16, 18, 19, 20, 21]} Cataract formation resulting from lightning injury typically occurs within days to weeks of injury. This complication has been reported as late as 2 years afterward but commonly occurs within the first week. (See Prognosis, Presentation, Treatment, and Medication.)

  Major complications are rare in mild and moderate lightning injuries, although musculoskeletal discomfort and subjective sensations of paresthesias, irritability, and other nonspecific neurologic sequelae may be present, depending on the location and intensity of the strike. In severe lightning injury with cardiopulmonary resuscitation (CPR) required in the field, permanent neurologic deficit and hypoxic injury are common.

  Complications of being struck by lightning include the following:

  • Chronic pain syndromes
  • Neuromuscular pain
  • Neurocognitive deficits including short-term memory loss, difficulty accessing or processing new information, attention deficit, personality change, distractibility, or loss of ability to multitask
  • Isolation or depression
  • Sympathetic nervous system dysfunction
  • Dizziness
  • Sleep disorders
  • Symptoms similar to postconcussion syndrome (eg, headaches, nausea, confusion)
  • Atypical seizure disorders

  Cardiopulmonary complications include the following:

  • Transient hypertension
  • Electrocardiographic changes
  • Myocardial injury
  • Congestive heart failure
  • Dysrhythmia
  • Transient asystole
  • Atrial fibrillation
  • Ventricular fibrillation
  • Frequent premature ventricular contractions
  • Respiratory complications
  • Apnea
  • Hypoxemia

  Damage to the central nervous system (CNS) is the second most debilitating group of lightning injuries.^[22] Neurologic complications include the following:

  • Immediate loss of consciousness
  • Amnesia and confusion
  • Retrograde amnesia
  • Hemiplegia, aphasia
  • Coma
  • Seizures
  • Intraventricular hemorrhage
  • Hematomas
  • Keraunoparalysis

  Vascular complications include the following:

  • Vasomotor instability
  • Arterial spasm
  • Vasoconstriction
  • Vasodilatation

  Ophthalmic complications include the following:

  • Cataracts
  • Macular holes
  • Corneal lesions
  • Hyphema
  • Iritis
  • Vitreous hemorrhage
  • Retinal detachment
  • Optic nerve injury

  Otologic complications include the following^[18] :

  • Ruptured tympanic membrane
  • Temporary hearing loss

  Gastrointestinal (GI) complications of lightning injuries are similar to those following any major trauma.^{[23, 24]} Most common is gastric atony with gastric dilatation, for which placement of a sump nasogastric tube is mandatory to decompress the stomach and remove swallowed air. Another complication seen in victims of lightning injury is GI bleeding, albeit a very rare complication. GI perforation is another rare complication of lightning injury.^{[24, 25]} Buffering the gastric secretions with antacids and administering cimetidine may prevent this. In 2 unusual fatal cases of lightning strike, autopsy findings showed hemorrhage and necrosis in the pancreas.
  
  
  (Source:http://emedicine.medscape.com/article/770642-overview#aw2aab6b2b2 )