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A shocking injury: A clinical review of lightning injuries highlighting pitfalls and a treatment protocol. Injury 2022; 53:3070-3077. [PMID: 36038387 DOI: 10.1016/j.injury.2022.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/07/2022] [Accepted: 08/10/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Lightning strikes have high morbidity and mortality rates. Thousands of fatalities are estimated to be caused by lightning worldwide, with the number of injuries being 10 times greater. However, evidence of lightning injuries is restricted to case reports and series and nonsystematic reviews. In this clinical review, we systematically select, score, and present evidence regarding lightning injuries. MATERIAL AND METHODS We performed a systematic search for reviews and guidelines in the PubMed, Embase (OvidSP), MEDLINE (OvidSP), and Web of Science databases. All publications were scored according to the Levels of Evidence 2 Table of the Oxford center for Evidence-Based Medicine. The reviews were also scored using the scale for the quality assessment of narrative review articles (SANRA) and guidelines from the Appraisal of Guidelines for Research & Evaluation (AGREE II). RESULTS The search yielded 536 articles. Eventually, 56 articles were included, which consisted of 50 reviews, five guidelines and one overview. The available reviews and guidelines were graded as low to moderate evidence. Most damage from lightning injuries is cardiovascular and neurological, although an individual can experience complications with any of their vital functions. At the scene, initial treatment and resuscitation should focus on those who appear to be dead, which is called the reverse triage system. We proposed an evidence-based treatment protocol for lightning strike patients. CONCLUSION It is vital that every lightning strike patient is treated according to standard trauma guidelines, with a specific focus on the possible sequelae of lighting injuries. All emergency healthcare professionals should acknowledge the risks and particularities of treating lighting strike injuries to optimize the care and outcomes of these patients. Our evidence-based treatment protocol should help prehospital and in-hospital emergency healthcare practitioners to prevent therapeutic mismanagement among these patients.
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Caballero-Carvajal JA, Manrique-Hernández EF, Becerra-Ar C, Alvarado-Socarras JL. Secondary maternal-fetal consequences to electrical injury: A literature review. Taiwan J Obstet Gynecol 2020; 59:1-7. [PMID: 32039774 DOI: 10.1016/j.tjog.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2019] [Indexed: 10/25/2022] Open
Abstract
Electrical injuries can occur in pregnant women but currently their incidence is not completely known. Notwithstanding, those represent clinical important events such maternal and fetal death, which can be avoided if properly managed. The objective of this paper is to describe the results of electrical injury (high and low voltage), in pregnant women in scientific reports. A systematic search was performed with keywords "electrical injuries", "lightning injuries", "lightning strike", "pregnant women" and "pregnancy", using the databases: MedLine, Scielo, Lilacs, Clinical key, Web of Science, Scopus, Springer, Science Direct, Embase and Medic Latina. Filters like language, time, design and availability of text were not used. Descriptive analyses were carried out for variables such as maternal-fetal consequences, voltage and type of exposure, based on the reports identified. From the total 74 cases identified, 71.1% survived after the exposition. From the total live-births 28.6% did not show any alteration, 7.1% presented maceration and burns, while 64.3% had another outcome. Electric injury leads to fetal compromise and death in exposed pregnant women, mainly in the first hours after the injury. However, monitoring should be continued for the risk of complications such as placenta abruption, oligohydramnios and fetal distress. It is possible an underreporting of these events.
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Affiliation(s)
| | - E F Manrique-Hernández
- Public Health Department, School of Medicine, Universidad Industrial de Santander, Bucaramanga, Colombia.
| | - C Becerra-Ar
- Health, Rehabilitation and Work Research Group - SARET - Universidad Manuela Beltran, Bucaramanga Campus, Colombia.
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Biswas A, Dalal K, Hossain J, Ul Baset K, Rahman F, Rahman Mashreky S. Lightning Injury is a disaster in Bangladesh? - Exploring its magnitude and public health needs. F1000Res 2016; 5:2931. [PMID: 28184286 PMCID: PMC5288675 DOI: 10.12688/f1000research.9537.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2016] [Indexed: 11/20/2022] Open
Abstract
Background: Lightning injury is a global public health issue. Low and middle-income countries in the tropical and subtropical regions of the world are most affected by lightning. Bangladesh is one of the countries at particular risk, with a high number of devastating lightning injuries in the past years, causing high mortality and morbidity. The exact magnitude of the problem is still unknown and therefore this study investigates the epidemiology of lightning injuries in Bangladesh, using a national representative sample. Methods: A mixed method was used. The study is based on results from a nationwide cross-sectional survey performed in 2003 in twelve randomly selected districts. In the survey, a total of 819,429 respondents from 171,336 households were interviewed using face-to-face interviews. In addition, qualitative information was obtained by reviewing national and international newspaper reports of lightning injuries sustained in Bangladesh between 13 and 15 May 2016. Results: The annual mortality rate was 3.661 (95% CI 0.9313–9.964) per 1,000,000 people. The overall incidence of lightning injury was 19.89/100,000 people. Among the victims, 60.12% (n=98) were males and 39.87% (n=65) were females. Males were particularly vulnerable, with a 1.46 times increased risk compared with females (RR 1.46, 95% CI 1.06–1.99). Rural populations were more vulnerable, with a 8.73 times higher risk, than urban populations (RR 8.73, 95% CI 5.13–14.86). About 43% of injuries occurred between 12 noon and 6 pm. The newspapers reported 81 deaths during 2 days of electric storms in 2016. Lightning has been declared a natural disaster in Bangladesh. Conclusions: The current study indicates that lightning injuries are a public health problem in Bangladesh. The study recommends further investigations to develop interventions to reduce lightning injuries, mortality and related burden in Bangladesh.
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Affiliation(s)
- Animesh Biswas
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Koustuv Dalal
- School of Health Sciences, Örebro University, Örebro, Sweden
| | - Jahangir Hossain
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Kamran Ul Baset
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Fazlur Rahman
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
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Gouse M, Arockiaraj J, Khanapur R, Srinivasan G. Transient paraplegia in an elderly due to lightning injury: An unusual cause. J Emerg Trauma Shock 2015; 8:238-9. [PMID: 26604533 PMCID: PMC4626944 DOI: 10.4103/0974-2700.166743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Mohamad Gouse
- Department of Orthopaedics and Spinal Disorder Surgery - Unit 1, Christian Medical College and Hospital, Vellore, Tamil Nadu, India E-mail:
| | - Justin Arockiaraj
- Department of Orthopaedics and Spinal Disorder Surgery - Unit 1, Christian Medical College and Hospital, Vellore, Tamil Nadu, India E-mail:
| | - Ronald Khanapur
- Department of Orthopaedics and Spinal Disorder Surgery - Unit 1, Christian Medical College and Hospital, Vellore, Tamil Nadu, India E-mail:
| | - Gangadaran Srinivasan
- Department of Orthopaedics and Spinal Disorder Surgery - Unit 1, Christian Medical College and Hospital, Vellore, Tamil Nadu, India E-mail:
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Davis C, Engeln A, Johnson EL, McIntosh SE, Zafren K, Islas AA, McStay C, Smith WR, Cushing T. Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update. Wilderness Environ Med 2015; 25:S86-95. [PMID: 25498265 DOI: 10.1016/j.wem.2014.08.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 08/24/2014] [Accepted: 08/26/2014] [Indexed: 11/26/2022]
Abstract
To provide guidance to clinicians about best practices, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the treatment and prevention of lightning injuries. These guidelines include a review of the epidemiology of lightning and recommendations for the prevention of lightning strikes, along with treatment recommendations organized by organ system. Recommendations are graded on the basis of the quality of supporting evidence according to criteria put forth by the American College of Chest Physicians. This is an updated version of the original WMS Practice Guidelines for Prevention and Treatment of Lightning Injuries published in Wilderness & Environmental Medicine 2012;23(3):260-269.
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Affiliation(s)
- Chris Davis
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO (Drs Davis, McStay, and Cushing).
| | - Anna Engeln
- Department of Emergency Medicine, Denver Health Medical Center/University of Colorado School of Medicine, Denver, Colorado (Dr Engeln)
| | - Eric L Johnson
- Department of Wound Healing and Hyperbaric Medicine, St. Alphonsus Hospital, Boise, ID, and Emergency Services, Teton Valley Hospital, Driggs, ID (Dr Johnson)
| | - Scott E McIntosh
- Division of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT (Dr McIntosh)
| | - Ken Zafren
- Division of Emergency Medicine, Stanford University Medical Center, Palo Alto, CA, the Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK, and the International Commission for Mountain Emergency Medicine (Dr Zafren)
| | - Arthur A Islas
- Department of Family & Community Medicine, Paul L. Foster School of Medicine (Dr Islas)
| | - Christopher McStay
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA
| | - William R Smith
- Department of Emergency Medicine, St. John's Medical Center, Jackson, WY (Dr Smith)
| | - Tracy Cushing
- Department of Emergency Medicine, Denver Health Medical Center/University of Colorado School of Medicine, Denver, Colorado (Dr Engeln)
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Sparić R, Malvasi A, Nejković L, Tinelli A. Electric shock in pregnancy: a review. J Matern Fetal Neonatal Med 2015; 29:317-23. [DOI: 10.3109/14767058.2014.1000295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Radmila Sparić
- Clinic of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia,
| | - Antonio Malvasi
- Department of Obstetrics and Gynecology, Santa Maria Hospital, Bari, Italy,
- Department of Applied Mathematics, International Translational Medicine and Biomodeling Research Group, Moscow Institute of Physics and Technology, Moscow State University, Russia,
| | - Lazar Nejković
- Clinic of Gynecology and Obstetrics “Narodni Front”, Belgrade, Serbia, and
| | - Andrea Tinelli
- Department of Applied Mathematics, International Translational Medicine and Biomodeling Research Group, Moscow Institute of Physics and Technology, Moscow State University, Russia,
- Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Department of Obstetrics and Gynecology, Vito Fazzi Hospital, Lecce, Italy
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Davis C, Engeln A, Johnson E, McIntosh SE, Zafren K, Islas AA, McStay C, Smith W‘WR, Cushing T. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Lightning Injuries. Wilderness Environ Med 2012; 23:260-9. [DOI: 10.1016/j.wem.2012.05.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 05/09/2012] [Accepted: 05/21/2012] [Indexed: 11/24/2022]
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