Lightning Injuries - Types, Causes, and Treatment

Introduction

Lightning is one of the top three environmental causes of death and a significant environmental cause of injury. Lightning usually strikes trees, towers, shelters, flagpoles, bleachers, fences, and other tall or isolated objects. In an open field, a person might be the tallest object. Water and metal are not attracted to lightning, but when struck, they readily transmit electricity. Lightning can directly strike a person or pass through the ground or a nearby object and then strike the person. Even in locations with clear skies, lightning has been seen to strike at distances of 10 miles or more from a storm, raising the possibility of unanticipated risk.

How Does Lightning Cause Injuries?

Although the number of injuries and fatalities caused by lightning strikes has significantly decreased over the past 50 years, according to estimates, 3000 burn unit admissions in the US occur due to lightning-related injuries each year. Lightning is not a direct current or an alternating current. Instead, it is a powerful, unidirectional current impulse that makes several returns to the cloud. Once the cloud connection has been established, a massive current flows impulsively for a brief period. The current exposure length is the key distinction between lightning and high-voltage electrical injuries.

The physics of lightning injury differs from that of generated electrical energy, knowledge of the effects of exposure to household current or high voltage cannot be generalized to lightning injuries. Voltage and amperage, for instance, are not factors that affect lightning-related damage. Lightning current flows for a very short time (1 per 10000 to 1 per 1000 second), despite having a lot of energy. In contrast to high-voltage and high-current electrical injury from generated sources, it rarely, if ever, results in serious skin wounds, rhabdomyolysis (breakdown of muscles), or serious internal tissue damage. Patients may experience intracranial hemorrhage from another injury or, very rarely, from lightning.

Although lightning can harm the heart, it mainly harms the nervous system, causing damage to the brain, autonomic nervous system, and peripheral nerves.

What Are the Types of Lightning Injuries?

There are five types of lightning injuries:

• Direct Strike - An uninterrupted connection between a lightning strike and a person or object.

• Contact Injury - Lightning strikes a victim's hand or another object (such as a car)

• Side Splash/Flash - Lightning strikes a nearby object or person, and the current splashes or jumps onto the victim in a side splash or flash.

• Ground Current (Step Voltage) - Lightning strikes a nearby ground and causes a ground current (step voltage) that enters the victim.

• Upward Streamer - An injury caused by an upward-moving current that passes through the victim without a nearby ground strike is known as an upward streamer (does not become part of the completed lightning channel).

What Are the Symptoms of Lightning Injuries?

Lightning injuries can cause mild to severe signs and symptoms. They might be temporary, or they might be permanent. Asystole and other arrhythmias, and symptoms of brain dysfunction like amnesia, confusion, or loss of consciousness, can all be brought on by an electrical charge.

Keraunoparalysis: It is characterized by sensory deficits, lower and occasionally upper extremity paralysis, mottling, coldness, and pulselessness. The sympathetic nervous system is most likely to blame for the injury. Keraunoparalysis is frequent and typically goes away in a few hours, though it can occasionally cause some degree of permanent paresis. Additional signs of lightning damage include:

• Loss of vision or hearing.

• Chest pain or an erratic or rapid heartbeat

• Breathing difficulty.

• Muscle aches, stiffness, weakness, or momentary paralysis.

• Weak or absent pulse, fainting.

• Punctate or feathered, branched, minor skin burns

• Perforation of the tympanic membrane

• Cataracts (within days)

• Confusion, poor cognitive function, and peripheral neuropathy are possible neurological issues. In addition, there may be neuropsychological issues, such as sleep disturbances, attention deficit, and memory issues.

Cardiopulmonary arrest is the most frequent cause of death during the strike. The most frequent long-term sequelae are cognitive deficits, pain syndromes, and sympathetic nervous system damage (including erectile dysfunction).

How Is a Lightning Injury Treated?

Immediate Care

• Cardiac arrest and respiratory failure are the two most serious injuries. Emergency care will frequently be needed right away for this. It is safe to administer care immediately because the victim will not continue to be electrically charged after the lightning has passed. Many people who are unresponsive and seem to be lifeless die from suffocation.

• For cardiac or respiratory arrest or both, cardiopulmonary resuscitation (CPR) is initiated. An automated external defibrillator should be used if one is available for cardiac arrest. Contrary to those who experience cardiac arrest due to other types of trauma, patients who experience cardiac arrest due to a lightning strike frequently have a good prognosis if revived. Therefore, when a lightning strike causes multiple casualties, such patients are given high priority in triage, unlike a typical mass-casualty event where such patients are given low priority.

• To reduce the possibility of brain edema, fluid intake is typically restricted. Unless cardiac effects or brain lesions are suspected, most lightning injury patients can be safely discharged.

Long-Term Care

During a thorough physical examination, paramedics or doctors may find a ruptured eardrum. After an otherwise uneventful recovery, ocular cataracts may appear, sometimes more than a year later. In addition, long-term neurological injuries typically cause memory loss, mood swings, and exhaustion.

How to Prevent Lightning Injuries?

• By adhering to lightning safety recommendations, most lightning injuries can be prevented.

• People should be aware of the weather forecast and have an evacuation strategy that involves moving to a safer location (ideally, a large, habitable building).

• While outside, people should keep an eye on the weather to use the escape strategy in the event of a storm. When thunder is heard, people should must seek shelter because they are already in danger (e.g., in a building or fully enclosed metal vehicle).

• Gazebos and other small, open structures are unsafe. People should not wander outside until 30 minutes have passed since the last lightning strike or thunder.

• People should avoid using plumbing and electrical equipment indoors during an electrical storm, stay away from windows and doors, and avoid using hardwired telephones, video game consoles, computers, or headsets connected by a cable to a sound system.

• Mobile phones, other portable electronics, and laptop computers are safe when operated solely on batteries because they do not attract lightning.

Conclusion

Lightning is one of the significant environmental causes of injury. Lightning injuries can cause mild to severe signs and symptoms. They might be temporary, or they might be permanent. The majority of lightning injuries can be avoided by staying indoors or following lightning safety recommendations.