[The dangers of lightning and protection from lightning in the mountains].
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Accident Prevention↗
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Lightning-related mortality and morbidity in Florida.
Cases of lightning-related deaths and injuries that occurred in Florida in 1978-87 were reviewed to determine the factors involved, to quantify the morbidity and mortality related to lightning strikes, and to describe epidemiologically the injuries and circumstances involved. Statewide information on deaths was obtained from death certificates, autopsy reports, and investigative reports. Information about morbidity was obtained from the Florida Hospital Cost Containment Board data base and the National Climatic Data Center data base for all Florida counties, as well as from hospitals in selected counties. Lightning-related deaths totaled 101 in Florida during the period 1978-87, an annual average of 10.1. Eight percent of the victims were from other States. The overall yearly death rate for State residents was 0.09 per 100,000 population, with the highest rate being that for men aged 15-19 years, 0.38 per 100,000. Thirteen percent of victims were females. The ratio of lightning-related injuries to deaths in Florida was estimated at about four to one. Thirty percent of all deaths were occupationally related. The first strikes of lightning from a thunderstorm may be the most dangerous, not in terms of impact, but because of the element of surprise. During thunderstorms, people may seek shelter under isolated trees because they believe erroneously that a tree offers protection from lightning, or perhaps because their top priority is to escape from rain rather than lightning. People may not seek adequate shelter during thunderstorms because they do not know the dangers of remaining outdoors or their judgment is impaired by drugs or alcohol.
Adolescent↗
[Lightning injuries in high mountain areas. Report of 29 cases].
Lightning, usually scarce, is a frequent phenomenon in high mountains. Due to our location at the foot of the Mont-Blanc, we have been able to examine twenty nine cases of people struck by lightning in the Chamonix Hospital. Lightning that has interested people since old times is the result of complex meteorological phenomenons, able to deliver a huge instant power. Several types of lightning have been described. They give different sorts of injuries; the most frequent affect the brain, the heart and the skin. The analysis of the results of seventeen victims admitted at the hospital does not allow to conclude to a clinical and biological specificity of the lightning stricken in high mountains. It makes it however possible to determine precisely the clinical disorders and the features of the injured and to emphasize the part due to the high mountains and consider the non specific therapeutic to set to work as soon as possible.
Adult↗
An epidemiological description of lightning-related deaths in the United States.
To better quantify and update the health impact of lightning and to compare potential sources of information, we reviewed data from the National Centre for Health Statistics (NCHS) database for 1968 through 1985 and from the North Carolina Medical Examiner (NCME) computerized database for 1972 through 1984. We epidemiologically characterized all lightning-related deaths identified in these databases. Results of our analysis are presented together with previously published information from the National Oceanic and Atmospheric Administration and from the National Institute for Occupational Safety and Health. In the US, Wyoming has the highest average annual lightning-related death rate (0.196/100,000), whereas Florida has the largest cumulative incidence of deaths (200) for this 18-year period. Death rates are the highest for males and for people 10-19 years old. There is a tendency toward a slight, but steady, decrease in the yearly incidence of lightning-related deaths. One-third of the fatalities are job-related. Both the NCHS and NCME databases are limited in describing the circumstances and aetiologies of these deaths.
Adolescent↗
Telephone-mediated lightning injury: an Australian survey.
Each year in Australia, about 60 people report injuries attributable to lightning surges while using a telephone during nearby thunderstorms. This paper presents information about such incidents and describes a retrospective survey of more than 300 telephone users reporting injuries possibly attributable to lightning. Questionnaires yielded 132 usable responses, and the results were analysed to identify the extent and nature of the lightning injuries. These are compared with direct strike injuries. Three distinct telephone-mediated lightning strike syndromes are identified (statistically) among the victims.
Australia↗
Telephone-related lightning injury.
OBJECTIVE: To review reported telephone-related lightning injuries, outline the mechanisms of injury and suggest treatment strategies. DATA SOURCES: Cases notified to Telecom Australia and an extensive search of the literature. DATA SYNTHESIS: There is a dearth of literature on telephone-related lightning injury. Some reports note it in passing, others describe single incidents. Case reports from Australia provide detail sufficient for review, and the general principles which govern management of such injuries are presented. CONCLUSION: Telephone-related lightning injury is not rare. Practitioners should be aware of the uniqueness of lightning injury and the complexity of its assessment. A research program aimed at further elucidation of the detail of this injury is proceeding.
Australia↗
Lightning injuries.
Lightning kills or injures thousands of people in the United States each year. Injuries are caused by the effects of electrical, thermal and mechanical energy, and a wide range of clinical results, involving multiple body systems, is possible. Important differences exist between lightning victims and patients injured by fire or by other forms of electricity. In lightning victims, successful resuscitation is highly likely, even among patients with conventional signs of brain death. With proper management, long-term physical and psychologic sequelae of lightning injury are rare.
Electric Injuries↗
The physical effects of lightning injury.
Several thousand lightning-related injuries occur each year in the United States resulting in nearly 600 deaths. Most incidents involve individual victims; group lightning strikes are rare. Ten soldiers were simultaneously injured in a group lightning strike while on training maneuvers at Fort Benning. Georgia. No deaths or loss of consciousness occurred, although two of the soldiers had amnesia for the event. All of the soldiers were hospitalized and observed for potential lightning-related complications. Ninety percent of the soldiers had first-degree skin burns, and all had focal muscular tenderness. Seventy percent had transient ST segment elevation that resolved. Fifty percent developed creatinine kinase (muscular component) elevation, but none developed myoglobinuria or acute renal failure. No patient had creatinine kinase (myocardial component) elevation. Transient hypertension and tinnitus were noted in 40% and 20%, respectively. No compartment syndromes or ocular manifestations developed. All 10 soldiers recovered uneventfully and returned to full active duty.
Adolescent↗
Lightning eye movements.
Physiologic studies were performed on a patient who demonstrated lightning eye movements, palatal myoclonus and myoclonic jerks of the left platysma and sternocleidomastoid muscles. The myoclonus and lightning eye movements were separate phenomena with no defined relationship to each other. Analysis of this ocular dyskinesia identified strictly horizontal saccadic oscillations, 2 to 5 Hz in frequency, with amplitudes varying greatly but often reaching 25 degrees. A brief stationary period between each saccadic oscillation was frequently observed. They were particularly induced by vertical or horizontal ocular pursuit as well as sustained upward or downward ocular deviation. Caloric nystagmus abolished the oscillations but they persisted, irregularly, during optokinetic nystagmus. Thus a faulty visual fixation mechanism is postulated to precipitate lightning eye movements. Constrast studies revealed a mass lesion arising from the right dorsolateral portion of the medulla. These results indicate that lightning eye movements occur with caudal as well as rostral brain-stem lesions. From the clinical findings cerebellar pathway involvement is likely.
Adult↗
Electrical injuries and lightning.
Prolonged cardiopulmonary resuscitation is key to the resuscitation of lightning strike victims. Multiple accounts exist of successful revival of victims thought to be "dead" or in patients who have what is often believed to be unresuscitatable cardiac dysrhythmia. Victims of lightning injury may, in addition to their electrical injury, have secondary injuries that require expedient care if significant morbidity is to be avoided. They should be treated as any victim of trauma, that is, with a complete and thorough evaluation including hospitalization if warranted. In the absence of a cardiac arrest or serious secondary injury, care for the lightning strike victim is generally supportive in nature.
Electric Injuries↗
Intracranial pressure (ICP) monitoring as a guide to prognosis in a lightning-injured, comatose child.
Every year there are many deaths due to lightning injuries in the United States. A case is presented of a young child who suffered cardiopulmonary arrest following being struck by lightning strike and in whom ICP monitoring was utilized. We postulate that ICP and CPP measurements may be useful as prognostic indicators for comatose lightning victims and, therefore, may help in the management of the patient.
Cerebrovascular Circulation↗
Acute polyneuropathy due to lightning injury.
The case of a 19 year old man struck by lightning is described. He sustained quadriplegia for several months and fully recovered. It is suggested that his weakness was due to extensive peripheral nerve damage. In addition, he displayed many well recognised medical complications of lightning injury including acute renal failure, rhabdomyolysis, respiratory distress syndrome, autonomic dysfunction, perforated ear drum, uveitis and cataract. The literature relating to the neurology of lightning strike is briefly reviewed.
Acute Disease↗
Lightning strikes.
Lightning strike is a natural phenomenon with potentially devastating effects. The physics of lightning strike and the physiology of lightning injury are discussed. Three cases are reported and the clinical features are described. Aspects of the management of such patients are discussed with particular emphasis on assessment and resuscitation in the Emergency Department.
Adult↗
Cutaneous manifestations of lightning injury.
This report calls attention to a bizarre, almost pathognomonic, cutaneous feature of lightning injury. It has been variously described as "lightning prints," "arborescent" burns, or "feathering," and has long been neglected in the dermatologic literature. Its recognition may be lifesaving in the unaccompanied comatose patient and is important because even delayed resuscitation of lightning victims can be very successful.
Adult↗
Temporary bulbar palsy following lightning strike.
Lightning is a significant cause of mortality in Zimbabwe. The same study showed that 21 per cent of fatal lightning strikes occurred with victims inside a hut. We report a case who survived a severe lightning strike with unusual features of a temporary bulbar palsy.
Aged↗
[Myocardial damage following lightning injury].
In a 27-year-old woman, struck by lightning behind the left ear, the ECG showed signs of an acute posterior-lateral myocardial infarction after 1 h of unconsciousness and loss of memory. Her serum enzymes were increased as is typical of myocardial infarction, but the patient did not complain of cardiac symptoms. Besides clear signs of lightning injury, the patient showed a hemorrhage throughout the left breast and transient pericardial effusion was observed by echocardiography. In the course of two months, the ECG revealed a regression to unspecific ST-T-deviations and serum enzymes became normal. TI-201-myocardial-scintigraphy (SPECT), done six days and two months after lightning injury, excluded reversible and irreversible perfusion defects.
Adult↗
Lightning-strike disaster among children.
A lightning strike involving 47 children is described. Four cases demonstrate the most common and serious resulting pathology: burns, myocardial infarction, and neurological symptoms varying from feelings of fear and nightmares to brain death. The pathophysiology of lightning injury is described. The importance of immediate resuscitation of the victim who appears dead after a lightning strike is emphasized, and procedures to prevent lighting injury are presented.
Adolescent↗
Destruction of hearing aid by lightning strike.
A 20-year-old woman was struck by lightning while seeking shelter under a tree. The discharge entered at the site of the victim's behind-the-ear type hearing aid, destroying it. She suffered cardiorespiratory arrest, burns, left ventricular failure, and myoglobinuria, yet recovered fully. It is widely known that carrying a metallic object such as an umbrella or golf club above one's head increases the risk of being struck. However, few people know that small metallic objects worn on the head are similarly dangerous. Persons caught outside in a lightning storm might decrease the probability of being struck by removing all metallic objects from their head.
Adult↗