Travel Reference
In-Depth Information
Several cutaneous injuries are characteristic of lightning strikes. Feathering is the dia-
gnostic change. This fernlike pattern branches away from a central spot, can extend 5 to
20 cm, appears within an hour after the incident, and resolves the same day. The pattern
is very similar to the experimentally induced electrical changes called Lichtenberg figures
that were described in the eighteenth century. Experimental studies have led investigators
to deduce that these lesions are caused by positive discharges over the skin and are not ac-
tually burns.
Aflowerlikepatternproducedbypunctateburnsisalesscommonskinmanifestation of
alightning strike. Theburnsmaybepartial orfullthickness. Linear partial-thickness burns
may occur in areas that are moist, such as the armpit or groin. In contrast to injuries from
high-voltage,humanmadeelectricity,distinctentranceandexitpointsmaynotbeapparent.
Thermalburnsmayresultfromignitionofclothingorfrommetalobjectsincontactwith
the skin, such as bracelets or necklaces.
The path of the current as it passes through the point of contact to the ground often de-
termines the type of injury:
◆
Hand-to-hand current can produce transection of the spinal cord in the lower neck and
also can cause current-induced cardiac rhythm abnormalities, particularly asystole.
(Mortality rate > 60 percent)
◆
Hand-to-footcurrentproducescurrent-inducedcardiacrhythmabnormalities.(Mortal-
ity rate > 20 percent)
◆
Foot-to-foot current produces fewer major problems. (Mortality rate < 5 percent)
CARE FOR INDIVIDUALS STRUCK BY LIGHTNING
Ifthelightningstrikeisnotwitnessed,determiningwhathashappenedtothepersonorper-
sons is often difficult. The differential diagnoses include trauma and assault, heart attack,
stroke, seizure, diabetes, and all the other disorders that must be considered for an uncon-
scious person with an unknown history. The presence of typical burn patterns, outdoor loc-
ation with a thunderstorm present, or rupture of the eardrums are diagnostic clues.
The major cause of death in lightning injuries is cardiopulmonary arrest. Initial assess-
mentandtreatmentmustbeinstitutedasquicklyaspossible.Mostlightningstrikesinvolve
single individuals; however, groups are sometimes involved. Reverse triage is a term ap-
pliedtotheappraisalofmultipleindividualsinjuredbylightning.Personswhoappeardead
following the strike should be treated before those who show signs of life because the per-
son who appears dead may be undergoing a secondary cardiac arrest caused by respiratory
arrest.Ifpeoplehitbylightningshowsignsoflife,theyhavesurvived.Iftheyappeardead,
they should be given an opportunity to outlast the period of respiratory arrest, either by be-
inggiven basic life supportthroughcardiopulmonary resuscitation (CPR) or,ifthey have a
heartbeat, through mouth-to-mouth resuscitation.
Steps to be taken include the following:
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