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Lightning-strike Injury

From the Department of Medicine, Dartmouth Medical School, Hanover, NH, and Veterans Administration Hospital, White River Junction, VT

Gene L. Colice, MD

From the Department of Medicine, Dartmouth Medical School, Hanover, NH, and Veterans Administration Hospital, White River Junction, VT

Although lightning-strike injury is uncommon, it is the cause of death in more people in the United States annu ally than any other natural disaster. Consequently, the emergency medicine specialist and intensivist should be familiar with the special problems of a lightning-strike victim. Lightning is a massive electrical discharge that results from a complex sequence of atmospheric events. When this massive electrical discharge strikes a human being, it causes predictable cardiac and neurological in juries. Synchronous myocardial contraction occurs at the moment of impact and is followed by a variable period of asystole. Prolonged asystole may cause isch emia and ventricular fibrillation. Alternatively, ventric ular fibrillation may occur primarily if the electrical discharge strikes during the vulnerable period of the cardiac cycle. Unconsciousness, depression of respira tory efforts, and seizures are also immediate conse quences of lightning strike. Respiratory arrest is pre sumed to be a consequence of inhibition of the medullary respiratory center. Retrograde and antegrade amnesia, confusion, disorientation, and vasomotor insta bility with transient paralysis of usually the lower ex tremities are commonly seen in lightning-strike victims. Other complications occur more variably, but should be carefully sought by the responsible clinician. These in clude burns at the exit and entrance sites of the light ning strike, eye injuries (e.g., cataracts, corneal lesions, intraocular bleeding), and rupture of the tympanic membrane. Besides describing the pathophysiology of these and other consequences of lightning strike, a com prehensive approach to the initial and long-term man agement of the lightning-strike victim is discussed.

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