Electrical injuries and lightning strikes Flashcards
What is the pathophysiology behind cardiac arrest in lightning strikes?
Direct depolarization of the myocardium leads to ventricular fibrillation or asystole.
What is the difference between direct and indirect lightning injuries?
Direct strike occurs when lightning directly hits the victim; indirect injuries occur via ground current, side flash, or contact transmission. Electrical injuries tend to be more common in working adults and accidental in children. Lightning involves a DC current that can be severe and is frequently fatal.
What is the immediate management of a lightning strike victim?
ABC approach, CPR if no pulse, cardiac monitoring, fluid resuscitation, and treatment of associated trauma.
Why is resuscitation of lightning strike victims different from typical electrical injuries?
Lightning strikes often cause primary respiratory arrest with secondary cardiac arrest, making aggressive resuscitation more effective. Summed up, even if CPR has been initiated for approximately 20 minutes, Continue CPR and ensure the ACLS algorithm is being followed. DC electrical injuries tend to manifest with asystole and AC electrical injuries tend to manifest with V fib.
Why are lightning strike victims prioritized in triage, even if unresponsive?
Unlike typical mass casualty triage, lightning victims with apnea may have intact circulation and are salvageable with aggressive resuscitation.
Why do lightning strike victims often survive compared to high-voltage electrical injuries?
Lightning has a brief duration (milliseconds) and a flashover effect, reducing deep tissue damage.
What is the ‘flashover phenomenon’ in lightning strikes?
Electricity travels over the surface of the body rather than penetrating deeply, reducing internal damage.
What is Lichtenberg Figure in lightning injuries?
A pathognomonic fern-like skin pattern due to transient capillary rupture from high-voltage energy discharge.
What is keraunoparalysis in lightning strikes?
Transient paralysis due to autonomic nervous system dysfunction, presenting as limb weakness or numbness. Lightning injury can cause temporary autonomic dysfunction with fixed and dilated pupils, and this finding should not preclude extended resuscitation efforts. Most victims of lightning injury are relatively young and have few clinical comorbidities, and they may recover even after a prolonged period of asystole
Which type of burn is most common in lightning strike injuries?
Superficial flash burns due to heat generated by lightning; deep burns are rare.
What ocular finding is commonly associated with lightning strikes?
Cataracts (may develop weeks to months after exposure due to thermal damage to the lens).
What otologic injury is common in lightning strike survivors?
Tympanic membrane rupture due to the blast effect of the strike. Tympanic membrane (TM) rupture from the blast effect of a lightning strike leads to conductive hearing loss.
What is the best imaging modality for evaluating internal injuries in lightning strikes?
CT scan to assess for intracranial hemorrhage, spinal cord injury, or traumatic fractures.
What are the most common musculoskeletal injuries in lightning strike victims?
Fractures and dislocations due to severe muscle contractions. Compartment syndrome is also a common manifestation along with bone necrosis.
What is the primary cause of death in lightning strike victims?
Cardiac arrest due to ventricular fibrillation (VF) or asystole.
What phenomenon makes lightning strike victims salvageable even in cardiac arrest?
Respiratory arrest may outlast cardiac arrest, meaning patients can be resuscitated with immediate CPR.
What is the classic ECG finding in a lightning strike victim?
Transient ST-T changes, prolonged QT interval, and possible arrhythmias (VF, asystole). Cardiac arrest due to lightning injury usually demonstrates 1 of 2 heart rhythms: ventricular fibrillation or asystole.
What are some secondary injuries seen in lightning strike survivors?
Blunt trauma from being thrown, traumatic brain injury, internal bleeding, and rhabdomyolysis.
What electrolyte abnormality can occur in severe lightning strike cases?
Hyperkalemia due to rhabdomyolysis and acute kidney injury (AKI).
What are the long-term neurological effects of lightning strikes?
Chronic pain, cognitive deficits, personality changes, and autonomic dysfunction.
