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Pesce F, Sannino E, Ragosta E, Esposito M, Del Monaco V, D'Amore M, Uberti BD, Fusco G, De Carlo E, Miletti G. Lightning deaths in three outdoor dogs: A case study. Res Vet Sci 2024; 174:105303. [PMID: 38820706 DOI: 10.1016/j.rvsc.2024.105303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/02/2024] [Accepted: 05/11/2024] [Indexed: 06/02/2024]
Abstract
This case report presents findings in three German Shepherd placed outdoor, dead after a night of thunderstorm.
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Affiliation(s)
- Federica Pesce
- Department of Animal Health, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Naples, Italy
| | - Emanuela Sannino
- Department of Animal Health, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Naples, Italy.
| | - Enza Ragosta
- Department of Animal Health, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Naples, Italy
| | - Mauro Esposito
- Department of Chemistry, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Naples, Italy
| | - Veronica Del Monaco
- Department of Animal Health, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Naples, Italy
| | - Marianna D'Amore
- Department of Animal Health, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Naples, Italy
| | - Barbara Degli Uberti
- Department of Animal Health, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Naples, Italy
| | - Giovanna Fusco
- Department of Animal Health, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Naples, Italy
| | - Esterina De Carlo
- National Reference Centre for Hygiene and Technologies of Water Buffalo Farming and Productions, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Salerno, Italy
| | - Gianluca Miletti
- Department of Animal Health, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Naples, Italy
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2
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Baker MB, Binda DD, Nozari A, Baker WE. The Silent Threat of Hypokalemia after High Voltage Electrical Injuries: A Case Study and Review of the Literature. J Clin Med 2024; 13:2852. [PMID: 38792394 PMCID: PMC11122100 DOI: 10.3390/jcm13102852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/03/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
High-voltage electrical injuries, especially from lightning strikes, can cause life-threatening complications due to extreme temperature and voltage exposure. While burns and cardiac complications have been widely described, the documentation of metabolic imbalances, particularly hypokalemia, has not been as prevalent. This report focuses on a patient with profound transient hypokalemia following a lightning strike, alongside a review of three similar cases of transient hypokalemia from the literature. Our patient, a previously healthy young man, was struck by lightning and subsequently suffered transient hypokalemia with lower extremity sensory changes, which resolved after the normalization of serum potassium levels. While the exact underlying mechanisms of transient hypokalemia following high-voltage electrical injuries are unknown, we propose a multifactorial mechanism, which includes massive intracellular shifts of potassium due to elevated epinephrine levels and the prevention of potassium efflux through the electrical disruption of voltage-gated potassium channels. Our report underscores the importance of recognizing hypokalemia in patients with high-voltage electrical injuries and contributes to the understanding of the complex mechanisms involved. Further research is necessary to understand the connection between cellular changes induced by high-voltage exposure and their effects on metabolism, particularly in relation to hypokalemia.
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Affiliation(s)
- Maxwell B. Baker
- Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA; (M.B.B.); (D.D.B.)
| | - Dhanesh D. Binda
- Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA; (M.B.B.); (D.D.B.)
| | - Ala Nozari
- Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA; (M.B.B.); (D.D.B.)
| | - William E. Baker
- Department of Emergency Medicine, University of Vermont Robert Larner College of Medicine, Burlington, VT 05401, USA;
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3
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Sumer RW, Woods WA. Cardiac Arrest in Special Populations. Cardiol Clin 2024; 42:289-306. [PMID: 38631796 DOI: 10.1016/j.ccl.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Best practices in cardiac arrest depend on continuous high-quality chest compressions, appropriate ventilatory management, early defibrillation of shockable rhythms, and identification and treatment of reversible causes. Although most patients can be treated according to highly vetted treatment guidelines, some special situations in cardiac arrest arise where additional skills and preparation can improve outcomes. Situations covered in this section involve cardiac arrest in context of electrical injuries, asthma, allergic reactions, pregnancy, trauma, electrolyte imbalances, toxic exposures, hypothermia, drowning, pulmonary embolism, and left ventricular assist devices.
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Affiliation(s)
- Ravi W Sumer
- Department of Emergency Medicine, 4601 Dale Road, Modesto, CA 95356-8713, USA.
| | - William A Woods
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908-0699, USA
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An SJ, Kayange L, Davis D, Peiffer S, Gallaher J, Charles A. Predictors of mortality following electrical and lightning injuries in Malawi: A decade of experience. Burns 2024; 50:754-759. [PMID: 37945505 PMCID: PMC10999340 DOI: 10.1016/j.burns.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/31/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Electrical injuries can be devastating, and data is lacking in low-resource settings. We aimed to identify predictors of mortality following electrical and lightning injuries (ELI) in Malawi. METHODS We performed a retrospective observational study of patients presenting with ELI and burn injuries at a tertiary hospital in Malawi from 2011 to 2020. Outcomes were compared and predictors of mortality were modeled. RESULTS A total of 382 ELI and 6371 burn patients were included. The mean ages for ELI and burn groups were 24 ± 14 and 11 ± 14 years, respectively (p < 0.01). Most patients were injured at home (91% in the burn group versus 51% in the ELI group, p < 0.01). The crude mortality rate in the ELI group was 28%, compared to 12% in the burn group (p < 0.01). On multivariate logistic regression, predictors of mortality included ELI (odds ratio [OR] 13.3, 95% confidence interval [CI] 7.2-24.5) and total body surface area burned (OR 1.1, 95% CI 1.1-1.1). Predicted mortality for ELI has increased over time (p = 0.05). CONCLUSIONS ELI confers more than 13 times higher odds of mortality than burn injuries in Malawi, with mortality risk increasing over time. More efforts are needed to prevent electrical hazards and implement timely interventions for patients with ELI.
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Affiliation(s)
- Selena J An
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett Womack Building, CB 7050, Chapel Hill, NC 27599, USA
| | - Linda Kayange
- Department of Surgery, Kamuzu Central Hospital, Private Bag 149, Lilongwe, Malawi
| | - Dylane Davis
- University of North Carolina at Chapel Hill, School of Medicine, 1001 Bondurant Hall, CB 9535, Chapel Hill, NC 27599, USA
| | - Sarah Peiffer
- Baylor College of Medicine, 1 Moursund St, Houston, TX 77030, USA
| | - Jared Gallaher
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett Womack Building, CB 7050, Chapel Hill, NC 27599, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett Womack Building, CB 7050, Chapel Hill, NC 27599, USA; Department of Surgery, Kamuzu Central Hospital, Private Bag 149, Lilongwe, Malawi.
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5
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Das A, Adhya S. Metallization and High Voltage Burn in Lightning. Am J Forensic Med Pathol 2024:00000433-990000000-00166. [PMID: 38442255 DOI: 10.1097/paf.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
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Idowu A, Adebolu O, Iyer I. Cardiac Manifestations in Patients Hospitalized For Lightning Strike Injury. Am J Cardiol 2023; 209:55-56. [PMID: 37863113 DOI: 10.1016/j.amjcard.2023.09.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 09/19/2023] [Accepted: 09/27/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Abiodun Idowu
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Olayinka Adebolu
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Indiresha Iyer
- Heart and Vascular Institute, Cleveland Clinic Akron General, Akron, Ohio.
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Byard RW. Thunder storm mortality: Issues of medicolegal concern. MEDICINE, SCIENCE, AND THE LAW 2023; 63:334-336. [PMID: 37041741 DOI: 10.1177/00258024231169230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Thunderstorms refer to atmospheric disturbances that are associated with electrical discharges in the form of lightning, with acoustic effects from thunder. They involve the rapid upward movement of warm, moist air which then cools and condenses creating typical cumulonimbus clouds with precipitation. Thunderstorms range in severity but are usually associated with heavy rains, winds and sometimes sleet, hail and snow. If the intensity of a storm increases there may be tornadoes or cyclones. In cases with lightning strikes and minimal or no rain there is an associated risk for the development of quite devastating wild (bush) fires. Lightning strikes may also be associated with the development, or an exacerbation, of potentially lethal natural cardiac or respiratory diseases.
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Affiliation(s)
- Roger W Byard
- Adelaide School of Medicine, The University of Adelaide, Adelaide, Australia
- Forensic Science SA, Adelaide, Australia
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8
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Sumer RW, Woods WA. Cardiac Arrest in Special Populations. Emerg Med Clin North Am 2023; 41:485-508. [PMID: 37391246 DOI: 10.1016/j.emc.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Best practices in cardiac arrest depend on continuous high-quality chest compressions, appropriate ventilatory management, early defibrillation of shockable rhythms, and identification and treatment of reversible causes. Although most patients can be treated according to highly vetted treatment guidelines, some special situations in cardiac arrest arise where additional skills and preparation can improve outcomes. Situations covered in this section involve cardiac arrest in context of electrical injuries, asthma, allergic reactions, pregnancy, trauma, electrolyte imbalances, toxic exposures, hypothermia, drowning, pulmonary embolism, and left ventricular assist devices.
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Affiliation(s)
- Ravi W Sumer
- Department of Emergency Medicine, 4601 Dale Road, Modesto, CA 95356-8713, USA.
| | - William A Woods
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908-0699, USA
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9
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Abstract
Following a witnessed lethal lightning strike of an adult male who was standing outside in a storm, numerous Lichtenberg figures were identified upon external examination of the body. Sectioning across multiple areas of linear erythema in the figures showed no subcutaneous hemorrhage. This was later confirmed on histology which showed only subtle dermal capillary dilatation with no interstitial hemorrhage or inflammation in these areas. The only areas of interstitial hemorrhage were present in adjacent scattered punctate burns from arcing. The documented resolution of Lichtenberg figures within hours would be more in keeping with temporary functional capillary dilatation, shown in this case, rather than with tissue alteration by interstitial hemorrhage or inflammation.
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Affiliation(s)
- Roger W Byard
- Adelaide School of Biomedicine, The University of Adelaide, Level 2, Room N237, Helen Mayo North, Adelaide, 5005, SA, Australia.
- Forensic Science SA, Adelaide, Australia.
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Simon T, Mayr GJ, Morgenstern D, Umlauf N, Zeileis A. Amplification of annual and diurnal cycles of alpine lightning. CLIMATE DYNAMICS 2023; 61:4125-4137. [PMID: 37854482 PMCID: PMC10579137 DOI: 10.1007/s00382-023-06786-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 04/10/2023] [Indexed: 10/20/2023]
Abstract
The response of lightning to a changing climate is not fully understood. Historic trends of proxies known for fostering convective environments suggest an increase of lightning over large parts of Europe. Since lightning results from the interaction of processes on many scales, as many of these processes as possible must be considered for a comprehensive answer. Recent achievements of decade-long seamless lightning measurements and hourly reanalyses of atmospheric conditions including cloud micro-physics combined with flexible regression techniques have made a reliable reconstruction of cloud-to-ground lightning down to its seasonally varying diurnal cycle feasible. The European Eastern Alps and their surroundings are chosen as reconstruction region since this domain includes a large variety of land-cover, topographical and atmospheric circulation conditions. The most intense changes over the four decades from 1980 to 2019 occurred over the high Alps where lightning activity doubled in the 2010 s compared to the 1980 s. There, the lightning season reaches a higher maximum and starts one month earlier. Diurnally, the peak is up to 50% stronger with more lightning strikes in the afternoon and evening hours. Signals along the southern and northern alpine rim are similar but weaker whereas the flatlands surrounding the Alps have no significant trend.
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Affiliation(s)
- Thorsten Simon
- Department of Mathematics, Universität Innsbruck, Technikerstrasse 21a, 6020 Innsbruck, Austria
- Department of Statistics, Universität Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Georg J. Mayr
- Department of Atmospheric and Cryospheric Sciences, Universität Innsbruck, Innrain 52, 6020 Innsbruck, Austria
| | - Deborah Morgenstern
- Department of Statistics, Universität Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
- Department of Atmospheric and Cryospheric Sciences, Universität Innsbruck, Innrain 52, 6020 Innsbruck, Austria
| | - Nikolaus Umlauf
- Department of Statistics, Universität Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Achim Zeileis
- Department of Statistics, Universität Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
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11
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Byard RW. Electrocution - post-mortem presentations, problems and pitfalls. Forensic Sci Med Pathol 2023; 19:91-93. [PMID: 36251236 DOI: 10.1007/s12024-022-00544-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 11/25/2022]
Abstract
Deaths due to electrocution occur when there has been passage of an electric current through the body. Lethal mechanisms may involve the heart with ventricular fibrillation, or the respiratory muscles or brainstem respiratory centres with respiratory paralysis/cessation. The size of the current that flows through the body is directly dependent on the potential difference of the circuit and the resistance of the tissues. The majority of deaths are accidental, with suicides being less common and homicides being very rare. Problems arising in the evaluation of cases include situations where electrocution has clearly occurred from the scene findings, but no injuries are detectable at autopsy, or when electrical burns are found at autopsy with no defective equipment/circuitry identified at the death scene.
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Affiliation(s)
- Roger W Byard
- School of Biomedicine, Level 2, Room N237, Helen Mayo North, The University of Adelaide, Forensic Science SA, Frome Road, Adelaide, South Australia, 5005, Australia.
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12
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Manoubi SA, Shimi M, Gharbaoui M, Allouche M. Lichtenberg Figures: How a Cutaneous Sign Can Solve Suspicious Death Cases. Wilderness Environ Med 2022; 33:473-475. [PMID: 36216673 DOI: 10.1016/j.wem.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/02/2022] [Accepted: 07/14/2022] [Indexed: 11/05/2022]
Abstract
Lightning is a natural weather phenomenon that occurs most commonly during the summer months in the afternoon or early evening. Lightning strikes can cause accidental deaths. In developed countries, lightning fatalities occur almost exclusively outdoors. Deaths from lightning may be in remote places with no witnesses. Forensic pathologists may not be able to reach the scene of death because it is too hazardous or inaccessible. Bodies may have neither evidence of skin burns nor torn areas on their clothes. The presumption of accidental death may be difficult to prove. We present 3 cases in which neither the examination of the death scene nor the examination of the bodies by those who attested to the death were performed. The bodies were transported to the morgue for a forensic autopsy because the deaths were considered suspicious. Physicians who attest to death in open spaces during weather that could produce lightning should actively search for Lichtenberg figures, which are considered irrefutable proof of fatal lightning in such settings. They should also photograph them and submit them as evidence. Nevertheless, physicians should keep in mind that Lichtenberg figures are not considered pathognomonic of lightning because some skin manifestations may mimic them.
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Affiliation(s)
| | - Maha Shimi
- Universite de Tunis El Manar Faculte de Medecine de Tunis, Tunis, Tunisia
| | - Meriem Gharbaoui
- Universite de Tunis El Manar Faculte de Medecine de Tunis, Tunis, Tunisia
| | - Mohamed Allouche
- Universite de Tunis El Manar Faculte de Medecine de Tunis, Tunis, Tunisia
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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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A 9-year retrospective review of lightning deaths from the Eastern Anatolian Region of Turkey. Forensic Sci Med Pathol 2022:10.1007/s12024-022-00512-2. [PMID: 35930215 DOI: 10.1007/s12024-022-00512-2] [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: 07/25/2022] [Indexed: 10/16/2022]
Abstract
In this study, deaths from lightning strikes in Eastern Turkey revealed distinct patterns in lifestyle and physical injury. Farmers, sailors, and those engaged in outdoor sports are all at risk of being struck by lightning. Death from a lightning strike is associated with cardiovascular and central nervous system damage. This study examines cases of autopsies that were performed on bodies that had suffered a lightning strike, including sociodemographic data, burns on the body, injured regions, histopathological findings, and causes of death. This retrospective evaluation included 17 cases. The cases comprised 88.2% males and 11.8% females, with a mean age of 41.5 years. The person's occupation was farmer in 29.4% of the cases and shepherd in 70.6%. Their deaths occurred most frequently in the summer months. Deaths associated with lightning strikes are more frequent in east of Turkey than in other regions, as agriculture and livestock are common sources of income. The majority of the victims among the cases were males working outside because of their occupations. Histopathologically, subarachnoid fresh bleeding was seen in five cases, subpleural fresh bleeding in the lungs in five cases, and interlobular rupture in the lungs in three cases. Deaths associated with lightning strikes have been correlated with a low level of education in this subject. This study is the largest case study of deaths associated with lightning strikes in Turkey.
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15
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A Storm, An Explosion, and Flying Rocks - An Unusual Injury due to a Lightning Strike in the Mountains. Prehosp Disaster Med 2022; 37:547-549. [PMID: 35754402 DOI: 10.1017/s1049023x22000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Most injuries observed in victims of lightning strikes can be explained by electrothermal phenomena. Blast penetrating injuries caused by a lightning-strike-induced explosion of a nearby structure are rarely reported. CASE PRESENTATION Here reported is the case of a patient with numerous mixed injuries caused by a lightning strike, including deep lacerations of both hips and thighs with rock fragments embedded in the wounds. Surgical removal of rock fragments from deep areas of the right hip and right lower leg was necessary. The cause of the formation of rock missiles was the lightning-strike-induced explosion of rock. Rapid evaporation of water enclosed in rock crevices was presumably the main force underlying the explosion. CONCLUSION Blast penetrating injuries should be considered and excluded in all patients struck by lightning, particularly when occurring in rocky terrain. The diagnosis and treatment of such injuries can be difficult and require special preparation.
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Pasieka P, Polak D, Pasieka P, Lechowicz D, Kisiołek L, Warmuz K, Konopka T, Moskała A, Rzepecka-Woźniak E, Juźwik E, Strona M, Kołodziej J, Kosiński S. The various pathological manifestations of a lightning strike exemplified in a single four-fatality incident - A case report and review of a literature. Leg Med (Tokyo) 2022; 58:102099. [PMID: 35752059 DOI: 10.1016/j.legalmed.2022.102099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 06/17/2022] [Indexed: 10/18/2022]
Abstract
The lightning strike is one of leading cases of weather-related death worldwide. We present an unusual case of four fatality-lightning strike with various pathological manifestations. All victims died from a single lightning strike in the mountains that also caused injury to 156 other people. All victims had mechanical damage and rock damage that are typical for lightning strikes in the mountainside. Another lesions indicative of lightning strike and electrical damage were, among others: burnt and torn clothes (all cases) current marks (Cases 1, 2 and 3) and Lichtenberg figures along with flashover marks on Case 1. In the review we described the pathophysiological mechanisms of lightning-induced lesions and injuries and epidemiological trends of lightning-strike deaths. Our study exemplifies various manifestations of lightning strikes on forensic examination and underlines the necessity to take lightning strike into consideration when investigating open-air deaths of unclear origin.
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Affiliation(s)
- Paweł Pasieka
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland.
| | - Dagna Polak
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland
| | - Patrycja Pasieka
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland
| | - Daria Lechowicz
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland
| | - Laura Kisiołek
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland
| | - Konrad Warmuz
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland
| | - Tomasz Konopka
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland.
| | - Artur Moskała
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland
| | - Ewa Rzepecka-Woźniak
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland
| | - Ewa Juźwik
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland.
| | - Marcin Strona
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland
| | - Jan Kołodziej
- Department of Forensic Medicine, Faculty of Medicine, Jagiellonian University Medical College in Kraków Grzegórzecka, 16 31-531 Kraków, Poland
| | - Sylweriusz Kosiński
- Faculty of Health Sciences, Jagiellonian University Medical College in Kraków Piotra Michałowskiego 12, 31-126 Kraków, Poland.
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Chen Y, Li Q, Wu W, Liu X, Cheng J, Deng X, Cai X, Yuan W, Xie J, Zhang S, Wang B. Effects of Lightning on Rhizosphere Soil Properties, Bacterial Communities, and Active Components of Camellia sinensis var. assamica. Front Microbiol 2022; 13:911226. [PMID: 35677900 PMCID: PMC9169052 DOI: 10.3389/fmicb.2022.911226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/29/2022] [Indexed: 11/24/2022] Open
Abstract
Lightning rods have been developed to prevent damage caused by lightning to organisms. However, the biological effect of the current transmitted into the soil through lightning rods is unknown. In this study, we analyzed the effects of lightning on soil properties, the microbial community, and the active components of Pu-erh tea (Camellia sinensis var. assamica) near lightning rods. The results showed that the contents of organic matter and available potassium, copper, and calcium in rhizosphere soil near the lightning rod were significantly higher than those in control soil (P < 0.05), while the contents of total potassium, phosphorus, iron, magnesium, and aluminum decreased. Lightning significantly increased the bacterial diversity of Pu-erh rhizosphere soil compared to control soil samples (P < 0.05). Sphingomonas, Nitrospira, and Reyranella were significantly enriched in soil samples near the lightning rod compared to soil samples far from the lightning rod. Clusters of Orthologous Groups (COG) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses indicated that adenosine/AMP kinase, chitodextrinase, flavorubredoxin, nucleotide metabolism, and carbohydrate digestion and absorption were significantly enriched in the rhizosphere soil samples near the lightning rod compared to the control samples (P < 0.05). β diversity analysis indicated the grounding of the lightning rod contributed to the community differentiation of rhizosphere bacteria. Amino acids, polyphenols, and soluble sugar increased in Pu-erh tea near the lightning rod, while the contents of catechin and anthocyanin decreased in Pu-erh tea near the lightning rod compared with the control sample (P < 0.05). Significant correlations were found among microbial indicators, soil properties, and Pu 'er tea components. This study serves as the first report on the effects of lightning rods on soil properties, microecology, and plant metabolism, which promotes the understanding of the biological effects of lightning, and provides a reference for the rational use of lightning resources.
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Affiliation(s)
- Yaping Chen
- College of Tea Science, Yunnan Agricultural University, Kunming, China.,College of Plant Protection, Yunnan Agricultural University, Kunming, China.,Yunnan Organic Tea Industry Intelligent Engineering Research Center, Kunming, China
| | - Qiang Li
- College of Food and Biological Engineering, Chengdu University, Chengdu, China
| | - Wendou Wu
- Yunnan Organic Tea Industry Intelligent Engineering Research Center, Kunming, China.,College of Big Data, Yunnan Agricultural University, Kunming, China.,Key Laboratory of Intelligent Organic Tea Garden Construction in Universities of Yunnan Province, Kunming, China
| | - Xiaohui Liu
- College of Tea Science, Yunnan Agricultural University, Kunming, China
| | - Jie Cheng
- College of Food and Biological Engineering, Chengdu University, Chengdu, China
| | - Xiujuan Deng
- College of Tea Science, Yunnan Agricultural University, Kunming, China
| | - Xiaobo Cai
- Yunnan Organic Tea Industry Intelligent Engineering Research Center, Kunming, China.,College of Big Data, Yunnan Agricultural University, Kunming, China.,Key Laboratory of Intelligent Organic Tea Garden Construction in Universities of Yunnan Province, Kunming, China
| | - Wenxia Yuan
- College of Tea Science, Yunnan Agricultural University, Kunming, China
| | - Jin Xie
- College of Tea Science, Yunnan Agricultural University, Kunming, China
| | - Shihao Zhang
- Yunnan Organic Tea Industry Intelligent Engineering Research Center, Kunming, China.,Key Laboratory of Intelligent Organic Tea Garden Construction in Universities of Yunnan Province, Kunming, China
| | - Baijuan Wang
- College of Tea Science, Yunnan Agricultural University, Kunming, China.,Yunnan Organic Tea Industry Intelligent Engineering Research Center, Kunming, China.,Key Laboratory of Intelligent Organic Tea Garden Construction in Universities of Yunnan Province, Kunming, China
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18
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Raniero D, Uberti A, Del Balzo G, Vermiglio E, Farinelli A, Turrina S, De Leo D. Unusual Lichtenberg figures in a lightning strike’s victim: Case report and literature review. Leg Med (Tokyo) 2022; 56:102028. [DOI: 10.1016/j.legalmed.2022.102028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/17/2022] [Accepted: 01/22/2022] [Indexed: 10/19/2022]
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19
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Cases of Lightning Strikes during Mountain-Sports Activities: An Analysis of Emergencies from the Swiss Alps. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073954. [PMID: 35409637 PMCID: PMC8998020 DOI: 10.3390/ijerph19073954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 02/01/2023]
Abstract
Background: Lightning strikes are a risk during mountain-sport activities. Yet little is known about the prevalence of injuries related to lightning strikes during mountain hiking, backcountry skiing, or high-altitude mountaineering. This study therefore examined the occurrence and characteristics of lightning-strike-related emergencies during mountain-sport activities in the Swiss Alps. Methods: We analyzed 11,221 alpine emergencies during mountain hiking, 4687 during high-altitude mountaineering, and 3044 during backcountry skiing in the observational period from 2009 to 2020. Identified cases were analyzed in detail regarding age, sex, the time of occurrence, altitude, location, the severity of the injury as quantified by its NACA Score (National Advisory Committee for Aeronautics Score), and injury pattern. Results: We found no cases related to backcountry skiing. Eight cases of lightning strikes during mountain hiking (four female and four male) were identified. The mean age was 32.5 ± 17.5 years, the mean NACA Score was 2.5 ± 1.9, and the mean altitude was 1883.8 ± 425.7 m. None of these cases were fatal, and only one victim was seriously injured. Fifteen cases were identified during high-altitude mountaineering (four female and 11 male). The mean age was 38.7 ± 5.2 years, the mean NACA Score was 3.1 ± 2.5, and the mean altitude was 3486.4 ± 614.3 m. Two lightning strikes were fatal. In these two cases, rope partners were injured by a lightning strike (NACA Score = 4). Most cases were on relatively exposed terrain, such as the Matterhorn Hörnligrat or the Eiger Mittellegigrat. Discussion: The typical victims were 30–40-year-old men. It is possible that the lightning strikes are a consequence of a lower risk aversion among these alpinists, which is be supported by the fact that most of the events occurred on famous mountains such as the Matterhorn or Eiger. Furthermore, since most of the locations were on relatively exposed terrain where one could not quickly find shelter, we recommend careful tour planning with serious consultation of the weather forecast and the likelihood of thunderstorms before climbing exposed sections to prevent emergencies related to lightning strikes.
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20
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Lightning Related Deaths In Istanbul, Between 2007-2012. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.935150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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Mariño RB, Martinez IS, Paños Gozalo ML, Zafren K. A Shocking Experience. Wilderness Environ Med 2021; 32:383-384. [PMID: 34083095 DOI: 10.1016/j.wem.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/27/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Robert Blasco Mariño
- Department of Anesthesiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Iñigo Soteras Martinez
- Department of Medical Science, University of Girona, Girona, Spain; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
| | | | - Ken Zafren
- Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, Alaska; Department of Emergency Medicine, Stanford University Medical Center, Stanford, California; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
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22
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Abstract
Lightning is the discharge of an electric charge forming in the atmosphere between the earth and clouds which travels downward in a branching pattern. It is estimated that there are some 1800 active thunderstorms at any given moment. Lightning may injure or kill a person by a direct strike, a side-flash or conduction through another object. Agricultural workers are at risk in developing and underdeveloped countries, as are those engaging in sporting activities elsewhere. Fatalities resulting from lightning strikes may not show specific symptoms at autopsy, but there may be symptoms of burns on clothes and body and fernlike marks specific to lightning strikes on their bodies. Other signs are acute kidney failure, cardiac arrhythmias and deaths, and while internal organs may show oedema, congestion, etc, this is not in itself sufficient to establish causation. When diagnosing death from a lightning strike, it is essential to examine the deceased's clothes, their external body and carry out a crime scene investigation. We report a series of three cases of death from a lightning strike in previously healthy men engaged in their daily activities.
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Affiliation(s)
- Kishor S Thakur
- Department of Forensic Medicine, South Bastar, Dantewada, India
| | - Nagendra S Sonwani
- Department of Forensic Medicine, University College of Medical Sciences & GTB Hospital, Delhi, India
| | - Navneet Ateriya
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Gorakhpur, India
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23
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Richardson C, Johnston K. An unusual case of high-voltage electrical injury involving fractal wood burning. J Am Coll Emerg Physicians Open 2021; 2:e12330. [PMID: 33521782 PMCID: PMC7819263 DOI: 10.1002/emp2.12330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 11/06/2022] Open
Abstract
A 26-year-old female was brought to the emergency department after an apparent electrocution. She was unresponsive, pulseless, and found to be in ventricular fibrillation upon arrival. The patient achieved return of spontaneous circulation after defibrillation. Further examination showed partial to full thickness burns to both hands, right chest wall, and buttocks. She was stabilized and then transferred to a regional burn center for additional care. Further history revealed the patient had learned how to create art with Lichtenberg figures using a high-voltage transformer extracted from a home microwave oven and a wooden canvas, a process called fractal wood burning. There are countless online video tutorials that describe how to replicate this process; however, the dangers of this practice are frequently omitted and have now become a growing public health concern. This article hopes to expand on the previous single publication, discuss the exceedingly high mortality rate, motivate emergency medicine providers and other clinicians to publish cases related to fractal wood burning-related injuries, and promote public awareness of this perilous practice.
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24
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Evolution of Lightning Maculopathy: Presentation of Two Clinical Cases and Brief Review of the Literature. Case Rep Ophthalmol Med 2021; 2021:8831987. [PMID: 33552607 PMCID: PMC7847350 DOI: 10.1155/2021/8831987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/05/2021] [Indexed: 11/18/2022] Open
Abstract
Lightning is a naturally occurring atmospheric phenomenon. Though uncommon, it is a potentially devastating and underreported natural calamity. Lightning accounts for the second leading cause of weather-related death in most parts of the world. Among the survivors of lightning injury, more than half of the victims may suffer from some form of ophthalmic injury. The lightning-associated ocular injury varies from a range of anterior segment to posterior segment pathologies. We report on two clinical cases of ocular injuries among the survivors of lightning injury. Anatomical involvement is seen at different levels with presentation as uveitis, pupillary abnormality, maculopathy, and later development of lenticular opacification. Optical coherence tomography (OCT), a noninvasive diagnostic tool, is particularly useful in the evaluation of lighting maculopathy as well as to monitor its progression through the course of time. Visual prognosis depends upon the structures of the eyes affected in the injury. The presence of irreversible retinal damage as well as optic nerve damage often result in poor visual outcome in the absence of significant anterior segment pathology. This report highlights the evolution of maculopathy through the course of time and signifies the importance of long-term follow-up postlightning injury.
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25
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George N, Bandi S, Ganti L, Umansky A, Desai B. Bounced off a Truck Out of the Blue: A Case Report of a Lightning Strike During a Thunderstorm. Cureus 2020; 12:e11534. [PMID: 33354478 PMCID: PMC7746318 DOI: 10.7759/cureus.11534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Lightning strikes are a relatively uncommon emergency department presentation, and due to the very high energy involved, can present quite dramatically, including cardiac arrest. However, as with many chief complaints, sometimes these patients can be discharged home after a benign emergency department evaluation. We present one such case of a male who was struck to the ground by lightning outside his truck, which subsequently caught on fire. He demonstrated the classic Lichtenberg figures associated with a lightning injury that evolved over time but was otherwise hemodynamically stable. After an unremarkable laboratory evaluation and electrocardiogram, he was safely discharged home.
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Affiliation(s)
- Nathan George
- Emergency Medicine, University of Central Florida, College of Medicine, Orlando, USA.,Emergency Medicine, Ocala Regional Medical Center, Ocala, USA.,Emergency Medicine, HCA Healthcare Graduate Medical Education Consortium, Ocala, USA
| | - Sumedha Bandi
- Emergency Medicine, University of Minnesota, Minneapolis, USA
| | - Latha Ganti
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA.,Emergency Medicine, Envision Physician Services, Orlando, USA.,Emergency Medicine, Osceola Regional Medical Center, Kissimmee, USA.,Emergency Medicine, HCA Healthcare Graduate Medical Education Consortium, Emergency Medicine Residency Program of Greater Orlando, Olrando, USA
| | - Aaron Umansky
- Emergency Medicine, University of Central Florida, College of Medicine, Orlando, USA.,Emergency Medicine, Ocala Regional Medical Center, Ocala, USA.,Emergency Medicine, HCA Healthcare Graduate Medical Education Consortium, Ocala, USA
| | - Bobby Desai
- Emergency Medicine, University of Central Florida, College of Medicine, Orlando, USA.,Emergency Medicine, Ocala Regional Medical Center, Ocala, USA.,Emergency Medicine, HCA Healthcare Graduate Medical Education Consortium, Ocala, USA.,Emergency Medicine, Envision Physician Services, Plantation, USA
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26
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Schön CA, Gordon L, Hölzl N, Milani M, Paal P, Zafren K. Determination of Death in Mountain Rescue: Recommendations of the International Commission for Mountain Emergency Medicine (ICAR MedCom). Wilderness Environ Med 2020; 31:506-520. [PMID: 33077333 DOI: 10.1016/j.wem.2020.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/27/2022]
Abstract
Determination of death requires specific knowledge, training, and experience in most cases. It can be particularly difficult when external conditions, such as objective hazards in mountains, prevent close physical examination of an apparently lifeless person, or when examination cannot be accomplished by an authorized person. Guidelines exist, but proper use can be difficult. In addition to the absence of vital signs, definitive signs of death must be present. Recognition of definitive signs of death can be problematic due to the variability in time course and the possibility of mimics. Only clear criteria such as decapitation or detruncation should be used to determine death from a distance or by laypersons who are not medically trained. To present criteria that allow for accurate determination of death in mountain rescue situations, the International Commission for Mountain Emergency Medicine convened a panel of mountain rescue doctors and a forensic pathologist. These recommendations are based on a nonsystematic review of the literature including articles on determination of death and related topics.
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Affiliation(s)
- Corinna A Schön
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Institute of Forensic Medicine, University of Bern, Bern, Switzerland.
| | - Les Gordon
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; University Hospitals, Morecambe Bay Trust, Royal Lancaster Infirmary, Lancaster, United Kingdom
| | - Natalie Hölzl
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Department of Anaesthesiology and Intensive Care, Klinikum Immenstadt, Germany
| | - Mario Milani
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Corpo Nazionale Soccorso Alpino e Speleologico, National Medical School (CNSAS SNaMed), Milan, Italy
| | - Peter Paal
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Ken Zafren
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland; Department of Emergency Medicine, Stanford University Medical Center, Stanford, CA; Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK
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27
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Blitzunfall. Rechtsmedizin (Berl) 2020. [DOI: 10.1007/s00194-020-00415-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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28
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Blitzunfall. Rechtsmedizin (Berl) 2020. [DOI: 10.1007/s00194-020-00406-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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29
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KAYA A, ÖZÇALIŞKAN B, TEMÜRKOL SC, ATA U. Yıldırım çarpması sonrası hayatta kalan bir olgunun adli-tıbbi değerlendirmesi. EGE TIP DERGISI 2020. [DOI: 10.19161/etd.756240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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30
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Pradhan E, Khatri A, Ahmed AA, Lama AJ, Khanal R, Bajracharya L, Adhikari S. Lightning Injury to Eye: Brief Review of the Literature and Case Series. Clin Ophthalmol 2020; 14:597-607. [PMID: 32184548 PMCID: PMC7053655 DOI: 10.2147/opth.s242327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 02/18/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose In ophthalmology, injuries due to lightning strikes have been documented as various entities ranging from keratitis, cataracts, uveitis in the anterior segments to retinal detachments, papillitis, and macular hole formation in the posterior segment. We report the largest case series so far with a total of seven cases of lightning injuries with ocular involvement and its management and a brief review of the literature on this topic. Patients and Methods All of the patients were evaluated for ocular injuries due to a lightning strike and each of the cases has been individually described as case series with their findings and management in this report. Results Ocular injuries caused by lightning are very rare, but when they occur, they can present with various ocular tissue pathology-ranging from anterior to the posterior segment structures. Most of the cases presented with maculopathy and foveschitic lesions, which resolved over time with the use of steroids. Conclusion Lightning injuries to the eyes, if detected early and managed appropriately, have a very good prognosis. The recovery is usually good with minimal functional loss if there is a quick referral. The macular region seems to be particularly involved in most cases and OCT can be a valuable diagnostic tool to detect and monitor the pathology.
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Affiliation(s)
- Eli Pradhan
- Department of Medical Retina, Tilganga Institute of Ophthalmology, Tilganga, Kathmandu, Nepal
| | - Anadi Khatri
- Department of Vitreo-Retina Services, Birat Eye Hospital, Biratnagar, Nepal
| | | | - Ang Jangmu Lama
- Department of Paediatric Ophthalmology, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Roshija Khanal
- Department of Vitreo Retina Services, ASG Hospitals, Kathmandu, Nepal
| | - Leena Bajracharya
- Department of Ophthalmology, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Srijana Adhikari
- Department of Pediatric Ophthalmology and Strabismus, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
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31
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Cardiac Arrest Secondary to Lightning Strike: Case Report and Review of the Literature. Pediatr Emerg Care 2020; 36:e18-e20. [PMID: 28767532 DOI: 10.1097/pec.0000000000001255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Lightning strike injuries, although less common than electrical injuries, have a higher morbidity rate because of critical alterations of the circulatory system, respiratory system, and central nervous system. Most lightning-related deaths occur immediately after injury because of arrhythmia or respiratory failure. We describe the case of a pediatric patient who experienced cardiorespiratory arrest secondary to a lightning strike, where the Advanced Cardiac Life Support and Basic Life Support chain of survival was well executed, leading to return of spontaneous circulation and intact neurological survival. We review the pathophysiology of lightning injuries, prognostic factors of favorable outcome after cardiac arrest, including bystander cardiopulmonary resuscitation, shockable rhythm, and automatic external defibrillator use, and the importance of temperature management after cardiac arrest.
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32
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Affiliation(s)
- Eric Mutter
- Department of Emergency Medicine (Mutter) and Division of Dermatology (Langley), The Ottawa Hospital, Ottawa, Ont
| | - Annie Langley
- Department of Emergency Medicine (Mutter) and Division of Dermatology (Langley), The Ottawa Hospital, Ottawa, Ont.
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33
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Lightning Injury in Children. Indian J Pediatr 2019; 86:969. [PMID: 31187449 DOI: 10.1007/s12098-019-02999-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
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Yrondi A, DerKasbarian R, Gallini A, Max V, Pauron C, Joubin A, Laguerre J, Virenque C, Birmes P. Symptoms of depression and post-traumatic stress in a group of lightning strike victims. J Psychosom Res 2019; 120:90-95. [PMID: 30929714 DOI: 10.1016/j.jpsychores.2019.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Lightning strike victims often suffer repercussions. Although a lightning strike constitutes a severe traumatic event, there is a lack of data about potential psychological sequelae. This is precisely the context in which we assessed the prevalence of Post-Traumatic Stress Disorder (PTSD) and Major Depressive Episode (MDE) in a group of lightning strike victims. METHODS The symptoms of peritraumatic dissociation were evaluated on the basis of the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) whilst the Peritraumatic Distress Inventory (PDI) was used to assess symptoms of distress. PTSD and MDE diagnoses were evaluated using the MINI (Mini International Neuropsychiatric Interview). Symptom intensity was assessed using the self-report PTSD Checklist-Specific (PCLS) and the Beck Depression Inventory II (BDI II), respectively. RESULTS Forty-nine patients were enrolled in the study. As regards symptoms of depression, 28 patients (57.1%) reported a major depressive episode (MINI) including 10 (20.4%) of moderate intensity and 5 (10.2%) of severe intensity (BDI). In terms of PTSD symptoms, 13 patients (26.5%) reported probable PTSD (MINI) with a PCL-S score ≥ 45. A significant correlation was established between PDEQ and BDI II (Spearman correlation coefficient = 0.36, p = .012). A significant correlation was also found between PDI and PCLS (Spearman correlation coefficient = 0.43, p = .002). A further significant correlation was noted between PDEQ and PCLS (Spearman correlation coefficient = 0.31, p = .028). DISCUSSION This study highlights the need for a multidisciplinary evaluation of lightning strike victims. Indeed, the prevalence of psychiatric disorders such as PTSD and MDE appears to be significant.
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Affiliation(s)
- Antoine Yrondi
- Service de Psychiatrie et de Psychologie Médicale de l'adulte, (Department of Adult Psychiatry and Medical Psychology), Centre Expert Dépression Résistante FondaMental (Expert Anti-Depression Centre), CHRU de Toulouse (Regional University Hospital Centre), Hôpital Purpan, ToNIC, Toulouse NeuroImaging Centre, Université de Toulouse (Toulouse University), Inserm, UPS, France.
| | - Raphael DerKasbarian
- Service de Psychiatrie et de Psychologie Médicale de l'adulte (Department of Adult Psychiatry and Medical Psychology), CHU Toulouse-Purpan (University Hospital Centre), Toulouse, France
| | - Adeline Gallini
- UMR1027, INSERM University of Toulouse, Toulouse, France; Department of Epidemiology and Public Health, Centre Hospitalier Universitaire Toulouse (University Hospital Centre), Toulouse, France
| | - Vincent Max
- Department of Epidemiology and Public Health, Centre Hospitalier Universitaire Toulouse (University Hospital Centre), Toulouse, France
| | - Christophe Pauron
- Service médecine d'urgence (Emergency Medicine Department), CHU-Toulouse (University Hospital Centre), Toulouse, France
| | - Audrey Joubin
- Centre Hospitalier de Mamoudzou (Hospital Centre), Mayotte, France
| | - Jacky Laguerre
- Service des grands brulés, pôle d'anesthésie-réanimation (Major Burns Unit, ICU Unit), CHU Toulouse-Rangueil (University Hospital Centre), Toulouse, France
| | | | - Philippe Birmes
- ToNIC, Toulouse NeuroImaging Centre, Université de Toulouse (Toulouse University), Inserm, UPS, France
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Ströhle M, Wallner B, Lanthaler M, Rauch S, Brugger H, Paal P. Lightning accidents in the Austrian alps - a 10-year retrospective nationwide analysis. Scand J Trauma Resusc Emerg Med 2018; 26:74. [PMID: 30201016 PMCID: PMC6131802 DOI: 10.1186/s13049-018-0543-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/31/2018] [Indexed: 11/10/2022] Open
Abstract
Background Lightning strikes are rare but potentially lethal. The risk for suffering a lightning strike in a mountain environment is unknown. The aim of this nationwide study was to analyse all lightning accidents in the Austrian Alps from 2005 to 2015, to assess the circumstances of the accident, the injury pattern as well as the outcome. Methods From 2005 to 2015, data from the national Austrian Alpine Police database as well as the Clinical Information System of Innsbruck Medical University Hospital were searched for the keywords lightning injury, lightning strike, lightning as well as ICD-10 Code T75.0. Additionally, the archive data of Innsbruck Medical University Hospital was searched manually. Results The Austrian Alpine Police database, containing 109.168 patients for the years 2005–2015, was screened for lightning accidents. Sixty-four patients had been hit by lightning in the Austrian Alps, 54 were male. Four persons died on scene; survival rate was 93.8%. Two deceased persons were hunters, who were killed by the same lightning strike. Sixty-three patients suffered a lightning strike while doing a recreational activity, mostly hiking (n = 55), a few hunting and only one doing occupational timberwork. Sixty-three patients suffered a lightning strike between June and August with nearly half (46.9%) of the accidents happening on a Saturday or Sunday, and mainly (95.3%) between 12:00 and 22:00 h. Discussion Persons who perform recreational outdoor and occupational activities in an alpine environment during summer and after noon incur a higher risk of sustaining a lightning strike. The primary risk group includes young male mountaineers and hunters. The mortality rate was low. Trial registration The study was approved by the Ethics Committee of the Medical University of Innsbruck (AN4757 315/4.4) and retrospectively registered with Clinical Trials NCT03405467, January 19, 2018.
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Affiliation(s)
- Mathias Ströhle
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bernd Wallner
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. .,Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy.
| | - Michael Lanthaler
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Simon Rauch
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy.,Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospital of the Brothers of St. John of God Salzburg, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
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36
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Eyerly-Webb SA, Solomon R, Lee SK, Sanchez R, Carrillo EH, Davare DL, Kiffin C, Rosenthal A. Lightning Burns and Electrical Trauma in a Couple Simultaneously Struck by Lightning. Clin Pract Cases Emerg Med 2018; 1:246-250. [PMID: 29849308 PMCID: PMC5965181 DOI: 10.5811/cpcem.2017.4.33706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/13/2017] [Accepted: 04/19/2017] [Indexed: 11/11/2022] Open
Abstract
More people are struck and killed by lightning each year in Florida than any other state in the United States. This report discusses a couple that was simultaneously struck by lightning while walking arm-in-arm. Both patients presented with characteristic lightning burns and were admitted for hemodynamic monitoring, serum labs, and observation and were subsequently discharged home. Despite the superficial appearance of lightning burns, serious internal electrical injuries are common. Therefore, lightning strike victims should be admitted and evaluated for cardiac arrhythmias, renal injury, and neurological sequelae.
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Affiliation(s)
| | - Rachele Solomon
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Seong K Lee
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Rafael Sanchez
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Eddy H Carrillo
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Dafney L Davare
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Chauniqua Kiffin
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
| | - Andrew Rosenthal
- Memorial Regional Hospital, Division of Acute Care Surgery and Trauma, Hollywood, Florida
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37
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Emet M, Aslan S, Cakir ZG, Onbas O, Sengul G, Saritas A. Subcortical Parenchymal and Right Lentiform Nucleus Haemorrhages in a Lightning Victim. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790901600309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report a 12-year-old lightning victim with right subcortical parenchymal and right lentiform nucleus haemorrhages documented by computed tomography (CT) and magnetic resonance imaging (MRI). A linear entry burn with an area of singed hair on the scalp was obvious. Neurological examination did not show any lateralized deficit. Cranial nerves were intact. A laceration on the right external auditory canal, elevated cardiac enzymes and electrocardiographic changes were also recorded. The boy was discharged on the sixth day. Prolonged loss of consciousness in lightning victims may suggest intracranial injury. Although brain CT can demonstrate intracranial haemorrhages, MRI is mandatory to show subcortical parenchymal haemorrhage in lightning victims.
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Affiliation(s)
| | | | | | - O Onbas
- Atatürk University, School of Medicine, Department of Radiology, 25090, Erzurum, Turkey
| | - G Sengul
- Atatürk University, School of Medicine, Department of Neurosurgery, 25090, Erzurum, Turkey
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38
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Delayed Onset of Atrial Fibrillation and Ventricular Tachycardia after an Automobile Lightning Strike. J Emerg Med 2017; 53:740-745. [PMID: 28882638 DOI: 10.1016/j.jemermed.2017.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/09/2017] [Accepted: 06/28/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Lightning strike is a rare medical emergency. The primary cause of death in lightning strike victims is immediate cardiac arrest. The mortality rate from lightning exposure can be as high as 30%, with up to 70% of patients left with significant morbidity. CASE REPORT An 86-year-old male was struck by lightning while driving his vehicle and crashed. On initial emergency medical services evaluation, he was asymptomatic with normal vital signs. During his transport, he lost consciousness several times and was found to be in atrial fibrillation with intermittent runs of ventricular tachycardia during the unconscious periods. In the emergency department, atrial fibrillation persisted and he experienced additional episodes of ventricular tachycardia. He was treated with i.v. amiodarone and admitted to cardiovascular intensive care unit, where he converted to a normal sinus rhythm on the amiodarone drip. He was discharged home without rhythm-control medications and did not have further episodes of dysrhythmias on follow-up visits. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Lightning strikes are one of the most common injuries suffered from natural phenomenon, and short-term mortality ordinarily depends on the cardiac effects. This case demonstrates that the cardiac effects can be multiple, delayed, and recurrent, which compels the emergency physician to be vigilant in the initial evaluation and ongoing observation of patients with lightning injuries.
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39
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Altalhi A, Al-Manea W, Alqweai N, Alothman M. Cardiac rhythm recorded by implanted loop recorder during lightning strike. Ann Saudi Med 2017; 37:401-402. [PMID: 28988255 PMCID: PMC6074195 DOI: 10.5144/0256-4947.2017.401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED Lightning strikes cause severe injuries and fatalities. Injuries vary from self-limiting skin manifestations to cardiac arrest and death. Because the event is sudden and unpredictable, assessment of the direct effects of the lightning on the human heart is usually impossible. In this case, a 16-year old boy who had an implanted loop recorder subcutaneous cardiac monitor was hit by lightning during a picnic and survived. A cardiac rhythm strip was recorded live during the strike. SIMILAR CASES PUBLISHED 0.
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Affiliation(s)
- Ali Altalhi
- Correspondence: Dr. Ali M Altalhi Department of Pediatrics, Security Forces Hospital Program, Riyadh, Saudi Arabia dr.ali.m.altalhi@ gmail.com http://orcid.org/000-0001-9339-9273
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40
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Apanga PA, Azumah JA, Yiranbon JB. A rare manifestation of burns after lightning strike in rural Ghana: a case report. J Med Case Rep 2017; 11:200. [PMID: 28738899 PMCID: PMC5525374 DOI: 10.1186/s13256-017-1378-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 07/02/2017] [Indexed: 11/10/2022] Open
Abstract
Background Lightning is a natural phenomenon that mostly affects countries in the tropical and subtropical regions of the globe, including Ghana. Lightning strikes pose a global public health issue. Although strikes to humans are uncommon, it is associated with high morbidity and mortality. Case presentation We present a case of a 10-year-old Ghanaian girl who got second-degree burns after being struck by lightning. She was put on an intravenous broad-spectrum antibiotic (ceftriaxone), Ringer’s lactate, and her burns were dressed with sterile gauze impregnated with Vaseline (petroleum jelly) and silver sulfadiazine ointment. There was marked improvement on the 16th day of treatment despite the lack in capacity of the hospital to carry out some laboratory diagnostic tests. On the 21st day of treatment, the burns were completely healed without scars and contractures. Conclusions This is evidence of burns due to lightning strike, despite its rare occurrence. This report will help inform those in doubt, particularly in communities where lightning injuries are associated with widespread superstition. The case report also revealed how rural healthcare can be challenging amid a lack of basic diagnostic equipment and logistics. However, in resource-limited settings, Vaseline (petroleum jelly) and silver sulfadiazine could be used in the treatment of burns.
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Affiliation(s)
| | - John Atigiba Azumah
- Talensi District Hospital, Ghana Health Service, Upper East Region, Tongo, Ghana
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41
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Tu Y, Lineaweaver WC, Zheng X, Chen Z, Mullins F, Zhang F. Burn-related peripheral neuropathy: A systematic review. Burns 2017; 43:693-699. [DOI: 10.1016/j.burns.2016.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 06/23/2016] [Accepted: 08/02/2016] [Indexed: 01/01/2023]
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42
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Cutaneous manifestations of lightning strike – variability in Lichtenberg figures. Forensic Sci Med Pathol 2017; 13:390-393. [DOI: 10.1007/s12024-017-9870-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2017] [Indexed: 10/19/2022]
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Gruhn KM, Knossalla F, Schwenkreis P, Hamsen U, Schildhauer TA, Tegenthoff M, Sczesny-Kaiser M. [Neurological diseases after lightning strike : Lightning strikes twice]. DER NERVENARZT 2017; 87:623-8. [PMID: 26873252 DOI: 10.1007/s00115-015-0062-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Lightning strikes rarely occur but 85 % of patients have lightning-related neurological complications. This report provides an overview about different modes of energy transfer and neurological conditions related to lightning strikes. Moreover, two case reports demonstrate the importance of interdisciplinary treatment and the spectrum of neurological complications after lightning strikes.
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Affiliation(s)
- K M Gruhn
- Neurologische Universitäts- und Poliklinik, Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland.
| | - Frauke Knossalla
- Neurologische Klinik, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Deutschland
| | - Peter Schwenkreis
- Neurologische Universitäts- und Poliklinik, Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - Uwe Hamsen
- Chirurgische Klinik und Poliklinik, Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - Thomas A Schildhauer
- Chirurgische Klinik und Poliklinik, Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - Martin Tegenthoff
- Neurologische Universitäts- und Poliklinik, Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - Matthias Sczesny-Kaiser
- Neurologische Universitäts- und Poliklinik, Ruhr-Universität Bochum, BG-Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
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45
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da Silva IRF, Frontera JA. Neurologic complications of acute environmental injuries. HANDBOOK OF CLINICAL NEUROLOGY 2017; 141:685-704. [PMID: 28190442 DOI: 10.1016/b978-0-444-63599-0.00037-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Environmental injuries can result in serious neurologic morbidity. This chapter reviews neurologic complications of thermal burns, smoke inhalation, lightning strikes, electric injury, near drowning, decompression illness, as well as heat stroke and accidental hypothermia. Knowing the pathophysiology and clinical presentation of such injuries is essential to proper management of primary and secondary medical complications. This chapter highlights the most frequently encountered neurologic injuries secondary to common environmental hazards, divided into the topics: injuries related to fire, electricity, water, and the extremes of temperature.
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Affiliation(s)
- I R F da Silva
- Neurocritical Care Unit, Americas Medical City, Rio de Janeiro, Brazil
| | - J A Frontera
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
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46
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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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48
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Zack F, Büttner A. Rechtsmedizinische Aspekte der Lichtenberg-Figuren nach Blitzschlag. Rechtsmedizin (Berl) 2016. [DOI: 10.1007/s00194-016-0104-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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49
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Schulze C, Peters M, Baumgärtner W, Wohlsein P. Electrical Injuries in Animals: Causes, Pathogenesis, and Morphological Findings. Vet Pathol 2016; 53:1018-29. [PMID: 27106738 DOI: 10.1177/0300985816643371] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Electrical injuries in animals occur most often accidentally. They comprise contact to various forms of currents, including alternating, rotary, or direct currents. Depending on various parameters of the current (including the type of circuit, voltage, current and duration of exposure) and conditions of the animal (such as wet or dry hair coat and pathway of current through the body), lesions may be absent or may include early or localized development of rigor mortis, signs of acute circulatory failure, or severe thermoelectrical burns. Such burns may present as external current marks, singed hair or feathers, metallization of the skin, or occasionally internal electroporation injury resulting in muscle necrosis, hemolysis, vascular damage with thrombosis, injury to brain and spinal cord, or skeletal fractures. Furthermore, lightning strikes occur regularly in grazing animals, which have greater risk of death from step potentials (ground current) in addition to direct strike and contact injury. Such cases may have no lesions, external signs of linear or punctate burns, keraunographic markings, or exit burns on the soles of the hooves or the coronary bands. Besides detailed information about the circumstances at the location where the animal was found, electrical injuries in animals require a thorough morphological workup, including additional investigations in conjunction with certain knowledge about the possible lesion spectrum.
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Affiliation(s)
- C Schulze
- Berlin-Brandenburg State Laboratory, Frankfurt (Oder), Germany
| | - M Peters
- Chemisches und Veterinäruntersuchungsamt Westfalen, Arnsberg, Germany
| | - W Baumgärtner
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - P Wohlsein
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
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50
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Blumenthal R. The Explosive Effects of Lightning: What are the Risks? Acad Forensic Pathol 2016; 6:89-95. [PMID: 31239875 DOI: 10.23907/2016.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/27/2015] [Accepted: 12/29/2015] [Indexed: 11/12/2022]
Abstract
The explosive effects of lightning have been known to exist for some time; however the precise risks associated with it have been generally unknown. This curious injury phenomenon has existed historically under many different names in the literature: "lightning's pressure blast wave," "arc blast," "shattering effects of lightning," "pressures developed by arcs," "thunder generation of shock waves," and "the sixth mechanism of lightning injury" are but a few of the many divergent and disparate terminologies used in the past to describe this invisible blast phenomenon. Blunt force trauma injuries and barotrauma injuries are often identified on lightning strike victims. Lightning's pressure blast wave and its associated overpressure does appear to have significant injury implications associated with it. This paper takes an in-depth look at the explosive effects of lightning and the main blast-related pathologies seen on lightning strike victims. Knowledge and insight into this phenomenon may help forensic pathologists and those working in the fields of lightning injury and lightning protection. A general literature search of the medical, the electrical engineering, and the mechanical engineering literature was conducted. By looking exclusively at the pathology of barotrauma in the human body, forensic pathologists may now get a relatively good idea as to the possible overpressures and distances involved with regards to lightning's explosive effects.
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