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Obszański B, Tułecki Ł, Kutarski A, Kleinrok A. Lightning-induced pacing system malfunction: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:5519815. [PMID: 31449643 PMCID: PMC6601167 DOI: 10.1093/ehjcr/ytz092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/04/2018] [Accepted: 05/27/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Atmospheric electrical discharge is an extremely powerful natural phenomenon which can have dangerous and lethal effects on the human body. However, there is no evidence to indicate whether and, if so, to what extent the electric current travelling through the body can affect proper pacemaker function. CASE SUMMARY An 80-year-old patient admitted to emergency department after being struck by a lightning bolt while riding a bike. The patient had a DDD pacemaker implanted 4 years prior to the incident. The ECG on admission depicted pacemaker spikes and native sinus rhythm at 50-60 b.p.m. On the 3rd day after admission the patient developed recurrent pacing-induced tachycardia. Pacemaker interrogation showed high pacing thresholds (failure to pace in the atrial channel). When the patient's condition stabilized she was transferred to the tertiary hospital for transcutaneous lead extraction. The extracted pacing system was sent to Biotronik for thorough evaluation. DISCUSSION Injuries due to a lightning strike are considered a rare occurrence but being struck by lightning with a pacemaker or an ICD is even less common. In the present case, the cause of cardiac arrhythmia was most probably electrical burn at the endocardial-electrode interface and a sudden elevation of the pacing threshold leading to transient pacing failure in both PM channels. To the best of our knowledge, in this case presentation we first described permanent lightning-induced pacemaker dysfunction.
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Affiliation(s)
- Bogdan Obszański
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamosc, Al. Jana Pawla II nr 10, Zamosc, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, The Pope John Paul II Province Hospital of Zamosc, Al. Jana Pawla II nr 10, Zamosc, Poland
| | - Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Aleje Racławickie 1, Lublin, Poland
| | - Andrzej Kleinrok
- Medical Department, The University of Information Technology and Management, Sucharskiego 2, Rzeszów, Poland
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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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Christophides T, Khan S, Ahmad M, Fayed H, Bogle R. Cardiac Effects of Lightning Strikes. Arrhythm Electrophysiol Rev 2017; 6:114-117. [PMID: 29018518 DOI: 10.15420/aer.2017:7:3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lightning strikes are a common and leading cause of morbidity and mortality. Multiple organ systems can be involved, though the effects of the electrical current on the cardiovascular system are one of the main modes leading to cardiorespiratory arrest in these patients. Cardiac effects of lightning strikes can be transient or persistent, and include benign or life-threatening arrhythmias, inappropriate therapies from cardiac implantable electronic devices, cardiac ischaemia, myocardial contusion, pericardial disease, aortic injury, as well as cardiomyopathy with associated ventricular failure. Prolonged resuscitation can lead to favourable outcomes especially in young and previously healthy victims.
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Affiliation(s)
| | - Sarosh Khan
- Epsom & St Helier University Hospitals NHS Trust, Carshalton, Surrey
| | - Mahmood Ahmad
- Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Hossam Fayed
- Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Richard Bogle
- Epsom & St Helier University Hospitals NHS Trust, Carshalton, Surrey
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Truhlář A, Deakin CD, Soar J, Khalifa GEA, Alfonzo A, Bierens JJLM, Brattebø G, Brugger H, Dunning J, Hunyadi-Antičević S, Koster RW, Lockey DJ, Lott C, Paal P, Perkins GD, Sandroni C, Thies KC, Zideman DA, Nolan JP, Böttiger BW, Georgiou M, Handley AJ, Lindner T, Midwinter MJ, Monsieurs KG, Wetsch WA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95:148-201. [PMID: 26477412 DOI: 10.1016/j.resuscitation.2015.07.017] [Citation(s) in RCA: 527] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, Southampton University Hospital NHS Trust, Southampton, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Annette Alfonzo
- Departments of Renal and Internal Medicine, Victoria Hospital, Kirkcaldy, Fife, UK
| | | | - Guttorm Brattebø
- Bergen Emergency Medical Services, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Hermann Brugger
- EURAC Institute of Mountain Emergency Medicine, Bozen, Italy
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - Rudolph W Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - David J Lockey
- Intensive Care Medicine and Anaesthesia, Southmead Hospital, North Bristol NHS Trust, Bristol, UK; School of Clinical Sciences, University of Bristol, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universitaet, Mainz, Germany
| | - Peter Paal
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, Queen Mary University of London, London, UK; Department of Anaesthesiology and Critical Care Medicine, University Hospital Innsbruck, Austria
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | | | - David A Zideman
- Department of Anaesthetics, Imperial College Healthcare NHS Trust, London, UK
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
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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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7
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Isolated Sensorineural Hearing Loss as a Sequela after Lightning Strike. Case Rep Otolaryngol 2015; 2015:738416. [PMID: 26161278 PMCID: PMC4487271 DOI: 10.1155/2015/738416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/18/2015] [Accepted: 06/07/2015] [Indexed: 11/17/2022] Open
Abstract
In most of the surviving patients after a lightning strike, audiovestibular abnormalities have been reported. The most frequently reported type of abnormalities is a tympanic membrane perforation with hearing loss and external ear canal burn. However a sensor neural hearing loss and mixed type hearing loss can also occur, but these occur rarely. A nineteen-year-old female patient had, after a lightning strike, serious burns on the left ear, behind the ear, and on the chest and neck. She also had in her left ear 108 dB hearing loss with irregular central perforation and in her right ear 52 dB sensorineural hearing loss. There was no hearing loss before the strike. A hearing aid was recommended for the right ear and good care and follow-up were recommended for the left ear. A lightning strike can cause serious audiological damage. Therefore, it is necessary to make a careful audiovestibular evaluation of the patients. Although there exist rarely healed cases from sensorineural hearing loss after lightning strike in literature, in our case hearing loss occurred bilaterally and then it healed unilaterally. This condition is quite rare in literature.
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Abstract
Electrical burns are classified as either high voltage (1000 volts and higher) or low voltage (<1000 volts). The typical injury with a high-voltage electrical contact is one where subcutaneous fat, muscles, and even bones are injured. Lower voltages may have lesser injuries. The electrical current has the potential to injure via three mechanisms: injury caused by current flow, an arc injury as the current passes from source to an object, and a flame injury caused by ignition of material in the local environment. Different tissues also have different resistance to the conduction of electricity. Voltage, current (amperage), type of current (alternating or direct), path of current flow across the body, duration of contact, and individual susceptibility all determine what final injury will occur. Devitalized tissue must be evaluated and debrided. Ocular cataracts may develop over time following electrical injury. Lightning strikes may conduct millions of volts of electricity, yet the effects can range from minimal cutaneous injuries to significant injury comparable to a high-voltage industrial accident. Lightning strikes commonly result in cardiorespiratory arrest, for which CPR is effective when begun promptly. Neurologic complications from electrical and lightning injuries are highly variable and may present early or late (up to 2 years) after the injury. The prognosis for electricity-related neurologic injuries is generally better than for other types of traumatic causes, suggesting a conservative approach with serial neurologic examinations after an initial CT scan to rule out correctable causes. One of the most common complications of electrical injury is a cardiac dysrhythmia. Because of the potential for large volumes of muscle loss and the release of myoglobin, the presence of heme pigments in the urine must be evaluated promptly. Presence of these products of breakdown of myoglobin and hemoglobin puts the injured at risk for acute renal failure and must be treated. The exact mechanism of nerve injury has not been explained, but both direct injury by electrical current overload or a vascular cause receive the most attention. Because electrical injuries carry both externally visible cutaneous injuries and possible hidden musculoskeletal damage, conventional burn resuscitation formulas based on body surface area injured may not provide enough fluid to maintain urine output. Damaged muscle resulting in swelling within the investing fascia of an extremity may result in compartment syndromes, requiring further attention. If myoglobin has been detected in the urine, treatment is aggressive volume resuscitation and possibly alkalinization of the urine or mannitol is given IV push to minimize pigment precipitation in the renal tubules. Approximately 15% of electrical burn victims also sustain traumatic injuries. This is because of falls from height or being thrown against an object. The tetanic contractions that result from exposure to electrical injury cause imbalance in flexor versus extensor muscles, with the flexor groups being stronger. Not only is the victim unable to release from the electrical contact, but they are at risk for fracture of bones from this prolonged muscular contracture. Neurologic and psychological symptoms were the most common sequelae of electrical and lightning injuries. Many of these symptoms are nonspecific, and they often do not appear until several months after the injury. A full neurologic examination must be performed on admission, documenting initial presentation and at any change in symptoms. Electrical injuries can have devastating consequences. Prevention of electrical injuries is clearly the preferable strategy for treatment.
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Affiliation(s)
- Arthur Sanford
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Richard L Gamelli
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA.
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9
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Gomes C. Lightning safety of animals. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2012; 56:1011-1023. [PMID: 22215021 DOI: 10.1007/s00484-011-0515-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 12/03/2011] [Accepted: 12/05/2011] [Indexed: 05/31/2023]
Abstract
This paper addresses a concurrent multidisciplinary problem: animal safety against lightning hazards. In regions where lightning is prevalent, either seasonally or throughout the year, a considerable number of wild, captive and tame animals are injured due to lightning generated effects. The paper discusses all possible injury mechanisms, focusing mainly on animals with commercial value. A large number of cases from several countries have been analyzed. Economically and practically viable engineering solutions are proposed to address the issues related to the lightning threats discussed.
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Affiliation(s)
- Chandima Gomes
- Department of Electrical and Electronics Engineering, Centre of Excellence on Lightning Protection, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
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10
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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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11
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Soar J, Perkins GD, Abbas G, Alfonzo A, Barelli A, Bierens JJLM, Brugger H, Deakin CD, Dunning J, Georgiou M, Handley AJ, Lockey DJ, Paal P, Sandroni C, Thies KC, Zideman DA, Nolan JP. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 2011; 81:1400-33. [PMID: 20956045 DOI: 10.1016/j.resuscitation.2010.08.015] [Citation(s) in RCA: 361] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
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12
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Soar J, Perkins G, Abbas G, Alfonzo A, Barelli A, Bierens J, Brugger H, Deakin C, Dunning J, Georgiou M, Handley A, Lockey D, Paal P, Sandroni C, Thies KC, Zideman D, Nolan J. Kreislaufstillstand unter besonderen Umständen: Elektrolytstörungen, Vergiftungen, Ertrinken, Unterkühlung, Hitzekrankheit, Asthma, Anaphylaxie, Herzchirurgie, Trauma, Schwangerschaft, Stromunfall. Notf Rett Med 2010. [DOI: 10.1007/s10049-010-1374-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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Abstract
Electrical injuries to the extremity can result in significant local tissue damage and systemic problems. An understanding of the pathophysiology of electrical injuries is critical to the medical and surgical management of patients who sustain these injuries.
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Affiliation(s)
- Brett D Arnoldo
- Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9158, USA.
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15
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Abstract
Lightning is an uncommon but potentially devastating cause of injury in patients presenting to burn centers. These injuries feature unusual symptoms, high mortality, and significant long-term morbidity. This paper will review the epidemiology, physics, clinical presentation, management principles, and prevention of lightning injuries.
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Saglam H, Yavuz Y, Yurumez Y, Ozkececi G, Kilit C. A case of acute myocardial infarction due to indirect lightning strike. J Electrocardiol 2007; 40:527-30. [PMID: 17543327 DOI: 10.1016/j.jelectrocard.2007.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Accepted: 03/12/2007] [Indexed: 11/17/2022]
Abstract
Lightning strike is a natural phenomenon with potentially devastating effects and represents one of the leading causes of cardiac arrest and death from environmental phenomena. Almost every organ system may be impaired as lightning passes through the human body preferring the pathways that the lowest resistance between the contact points. Lightning can also have widespread effects on the cardiovascular system, producing extensive catecholamine release or autonomic stimulation. The victim may develop hypertension, tachycardia, nonspecific electrocardiographic changes (including prolongation of the QT interval and transient T-wave inversion), and myocardial necrosis with release of creatine phosphokinase-MB fraction. We present the case of a 13-year-old boy with acute myocardial infarction secondary to an indirect lightning strike.
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Affiliation(s)
- Hayrettin Saglam
- Afyonkocatepe University of Medical School, Department of Cardiology, Afyonkarahisar, Turkey
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Rivera J, Romero KA, González-Chon O, Uruchurtu E, Márquez MF, Guevara M. Severe stunned myocardium after lightning strike. Crit Care Med 2007; 35:280-5. [PMID: 17133184 DOI: 10.1097/01.ccm.0000251129.70498.c1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report the development of myocardial stunning and severe heart failure after lightning strike with total recovery of function. DESIGN Case report. SETTING Coronary care unit at Medica Sur Clinic, Mexico. PATIENT A 42-yr-old woman who was hit by lightning developed rapid and progressive hemodynamic deterioration manifested by cardiogenic shock that required invasive monitoring. Twenty-four hours after the strike, intravenous levosimendan and intra-aortic balloon pump were initiated because the patient demonstrated no significant response to management with conventional inotropic agents. Two days later, echocardiographic signs of systolic and diastolic dysfunction improved markedly. Dual-isotope-imaging myocardial perfusion testing with technetium-99m-sestamibi and thallium-201, performed 9 days after admission, showed normal perfusion and normal left ventricular systolic function. The patient exhibited complete recovery of function. The exact mechanism of abnormal contractility in the absence of direct electrofulguration is unknown but may be explained by release of oxygen free radicals, proteolysis of the contractile apparatus, and cytosolic overload of intracellular calcium, followed by reduced myofilament sensitivity to calcium. These abnormalities are consistent with stunned myocardium. CONCLUSIONS Lightning strike may cause serious contractile dysfunction in the absence of irreversible myocardial injury, but the exact mechanism of this phenomenon remains unknown. We propose that lighting strike can cause myocardial stunning resulting in severe but reversible left ventricular dysfunction. The patient's recovery was facilitated by support treatment including administration of levosimendan, which increases the intracellular sensitivity to calcium, a mechanism disturbed in patients with myocardial stunning.
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Affiliation(s)
- Jaime Rivera
- Department of Cardiology, Medica Sur Clinic, Mexico City, Mexico
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Stütz N, Weiss D, Reichert B. [Lightning injuries: case report of a 17-year-old man and a brief review of the literature]. Unfallchirurg 2006; 109:495-8. [PMID: 16773325 DOI: 10.1007/s00113-006-1110-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Lightning injury is one of the most frequent injuries caused by a natural phenomenon, but the risk of being struck by lightning is low. The most vulnerable subjects for lightning injuries are individuals who work in open fields. Although lightning injuries may involve all organ systems, injuries to the cardiovascular system and central nervous system are the most frequent. Burns, tinnitus, blindness and secondary blunt trauma have also been reported. Even though immediate death through lightning-induced cardiac arrest is well documented, the majority of cases reported in the literature describe infrequent and enormously disparate sequelae.A 17-year-old man was admitted to our hospital approximately 3 h after a lightning strike. The Glasgow coma scale was recorded as 15/15 and partial thickness burns totaling of 11% were present on the chest, stomach and right and left lower leg. The entry point was approximately the right side of the neck and the current exited through the right foot. On arrival, the patient's vital signs were normal. Cardiac and pulmonary examinations were within normal limits. The patient suffered transient symptoms, including pain, loss of consciousness, tinnitus, iritis and paresthesia. The laboratory data obtained on admission were within normal limits except serum for WBC, CK, CK-MB, troponin and CRP. We postulate that the mechanism by which lightning caused injury to this patient was a flash discharge (side splash). During his stay in hospital, a debridement of the burn surface following graft coverage and Z-plasty to close the dehiscent wound on the right neck was performed. The patient was discharged from the hospital after 14 days.
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Affiliation(s)
- N Stütz
- Abteilung für Plastische-, Hand und Wiederherstellungschirurgie, Zentrum für Schwerbrandverletzte, Klinikum Nürnberg-Süd, Breslauerstrasse 201, 90471 Nürnberg.
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Soar J, Deakin CD, Nolan JP, Abbas G, Alfonzo A, Handley AJ, Lockey D, Perkins GD, Thies K. European Resuscitation Council guidelines for resuscitation 2005. Section 7. Cardiac arrest in special circumstances. Resuscitation 2006; 67 Suppl 1:S135-70. [PMID: 16321711 DOI: 10.1016/j.resuscitation.2005.10.004] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
The pathological and histopathological examination of two female roe deer found dead after a severe thunderstorm is described. One of the two roe deer was killed by a direct hit of atmospheric flash, while the other animal, lying 1.5 m from the first one, died as a consequence of ground current strike. The major part of the coat and skin of the animal that was killed by a direct hit was covered with scorched streaks. The trachea and bronchi of both animals contained a considerable amount of aspirated light-red foam. Necropsy revealed diffuse haemorrhages over the epicardium of the right atrium with a diameter of 1 millimetre. The liver and the kidney exhibited severe congestion.
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Affiliation(s)
- Diana Zele
- Institute for Breeding and Health Care of Wild Animals, Fishes and Bees, Veterinary Faculty, University of Ljubljana, 1000 Ljubljana, Gerbiceva 60, Slovenia.
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21
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Kreislaufstillstand unter besonderen Umständen. Notf Rett Med 2006. [DOI: 10.1007/s10049-006-0798-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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García Gutiérrez JJ, Meléndez J, Torrero JV, Obregón O, Uceda M, Gabilondo FJ. Lightning injuries in a pregnant woman: a case report and review of the literature. Burns 2005; 31:1045-9. [PMID: 16308099 DOI: 10.1016/j.burns.2005.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2004] [Accepted: 01/28/2005] [Indexed: 10/25/2022]
Affiliation(s)
- J J García Gutiérrez
- Department of Plastic Surgery and Burns Unit, Hospital de Cruces, Plaza de Cruces S/N, Baracaldo, Vizcaya, Spain.
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Zafren K, Durrer B, Herry JP, Brugger H. Lightning injuries: prevention and on-site treatment in mountains and remote areas. Resuscitation 2005; 65:369-72. [PMID: 15919576 DOI: 10.1016/j.resuscitation.2004.12.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2004] [Revised: 11/19/2004] [Accepted: 12/21/2004] [Indexed: 11/21/2022]
Abstract
Lightning is a hazard during outdoor activities, especially for hikers and mountaineers. Specific preventive measures include staying off ridges and summits, and away from single trees. If possible, stay close to a wall but keeping a distance of at least 1m away from the wall. All metal objects (carabiners, crampons, ice-axe, ski poles, etc.) should be removed and stored away safely. Lightning currents can follow wet ropes. To prevent blunt trauma the helmet should not be removed. Move as quickly as possible away from wire ropes and iron ladders. The crouch position should be adopted immediately if there is a sensation of hair "standing on end". Crackling noises or a visible glow indicate an imminent lightning strike. Rescue of lightning victims may be hazardous. Airborne helicopters can be struck by lightning with disastrous effects. It is prudent to wait until the danger of further strikes has passed. Treatment of lightning victims is based upon the ABCs - (Assessment) airway, breathing and circulation. Victims who are not breathing can often be resuscitated and should be helped first. Respiratory arrest may be prolonged, but the prognosis can be excellent if breathing is supported. Standard Advanced Life Support (ALS), if necessary, should be given at the scene.
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Affiliation(s)
- Ken Zafren
- Division of Emergency Medicine, Stanford University Medical Center, 701 Welch Road, Building C, Palo Alto, CA 94304, USA
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Blumenthal R. Lightning fatalities on the South African Highveld: a retrospective descriptive study for the period 1997 to 2000. Am J Forensic Med Pathol 2005; 26:66-9. [PMID: 15725779 DOI: 10.1097/01.paf.0000154115.12168.46] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A review of the Southern Africa medical literature shows a paucity of published data regarding lightning fatalities. The South African Highveld has a lightning ground flash density of 6 to 9 flashes/km/year, with a high incidence of thunderstorm days per year (some 40-70). The Highveld has a largely urban population, many of whom have low socioeconomic status and poor education, housing, and other infrastructures and hence (possibly) are at greater exposure risk. Thirty-eight victims of lightning-related death were identified from the records of the 6 large medicolegal mortuaries on the South African Highveld, serving a population of approximately 7 million, for the period 1997 to 2000. Analysis of the records revealed that 95% of all victims were black, 79% were male, and the average age was 36 years. Lightning strikes occurred from September through to April (normal summer rainfall period), and the most strikes took place in the late afternoon (3:00 pm to 6:00 pm). All except 1 case occurred outdoors. In the autopsy reports, mention was made of singeing of hair in 68% of cases, and mention of damage to clothing was made in 26% of cases. Cutaneous thermal injuries were noted in 34 of the 38 cases, with apparent electrothermal injuries of the feet noted in 4 cases. Fifty-two percent of victims sustained some form of associated blunt-force injury (including abrasions, contusions, etc). Specific keraunopathologic injuries were described in only 2 of the cases. Twenty-one cases had some form of internal organ injury. This study serves to illustrate the relatively high incidence of lightning strikes in the region and calls for a more systematic and detailed investigative protocol in lightning-related deaths.
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Affiliation(s)
- Ryan Blumenthal
- Department of Forensic Medicine, University of Pretoria, Pretoria, South Africa.
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Aslan S, Aydinli B, Ocak T, Akcay M. Lightning: an unusual etiology of gastrointestinal perforation. Burns 2005; 31:237-9. [PMID: 15683701 DOI: 10.1016/j.burns.2004.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2004] [Indexed: 11/21/2022]
Affiliation(s)
- Sahin Aslan
- Department of Emergency Medicine, Ataturk University, School of Medicine, 25090 Erzurum, Turkey.
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26
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Abstract
Three pigs, weighing 63 kg-70 kg each, from a group of 8 pigs in an outdoor pen that was struck by lightning were necropsied. All 3 pigs presented with hind limb paralysis. The only lesions identified were multiple fractures of the last (seventh) lumbar vertebral body and first sacral vertebral segment, with dorsal displacement of the sacrum and transection of the distal spinal cord and spinal nerves. Hemorrhages extended from the fracture sites into muscles immediately surrounding the lumbosacral junction and retroperitoneally into the pelvic cavity. These hemorrhages were not clearly visible until the pelvic region was dissected. Lesions commonly found in human lightning-strike victims were not present in these pigs. Because vertebral fractures may be the only lesions and may be grossly subtle in heavily muscled pigs, careful pelvic and vertebral dissection is recommended in cases of suspected lightning strike and electrocution.
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Affiliation(s)
- William G Van Alstine
- Animal Disease Diagnostic Laboratory, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907-1175, USA
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27
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Abstract
Lightning strikes kill 1,000 people per year worldwide. Cardiac arrests resulting from lightning strikes have good survival rates but there is a significant degree of morbidity amongst the survivors. This is the case report of a 13-year-old boy who had a cardiac arrest following a direct lightning strike, and his subsequent management.
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Affiliation(s)
- S P Courtman
- Department of Paediatric Intensive Care, Great Ormond Street Hospital for Sick Children, London, UK.
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28
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Abstract
Electrical injury is a relatively infrequent but potentially devastating form of multisystem injury with high morbidity and mortality. Most electrical injuries in adults occur in the work-place, whereas children are exposed primarily at home. In nature, electrical injury occurs due to lightning, which also carries the highest mortality. The severity of the injury depends on the intensity of the electrical current (determined by the voltage of the source and the resistance of the victim), the pathway it follows through the victim's body, and the duration of the contact with the source of the current. Immediate death may occur either from current-induced ventricular fibrillation or asystole or from respiratory arrest secondary to paralysis of the central respiratory control system or due to paralysis of the respiratory muscles. Presence of severe burns (common in high-voltage electrical injury), myocardial necrosis, the level of central nervous system injury, and the secondary multiple system organ failure determine the subsequent morbidity and long-term prognosis. There is no specific therapy for electrical injury, and the management is symptomatic. Although advances in the intensive care unit, and especially in burn care, have improved the outcome, prevention remains the best way to minimize the prevalence and severity of electrical injury.
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Affiliation(s)
- Anastassios C Koumbourlis
- Division of Pediatric Critical Care, College of Physicians and Surgeons of Columbia University, Morgan Stanley Children's Hospital of New York Presbyterian, New York, NY, USA
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29
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Abstract
There is no absolute protection against lightning because of its random and capricious nature. However, the risk of being struck by lightning can be substantially reduced. There are general safety rules that apply to all athletic and recreational events. The athlete should have a proactive plan that can be instituted when storms approach. He/she should go to a safe shelter before the storm arrives and stay there until the danger is gone. Because the location, climate, terrain and playing site vary with different sporting activities, safety plans may have distinct elements for different recreational activities. Mountain climbers should know the weather patterns of their locale. The highest frequency of lightning strikes in the Rocky Mountains occurs between 11 am and 9 pm during the months of April to September. There is less chance of a hiker encountering lightning during the early morning hours. Many tourists are unaware of this pattern, which may possibly explain the finding that most lightning victims are visitors from other states. The bicyclist is as vulnerable as anyone in the open. In the event of lightning he/she should seek safe shelter and get off the bike. Rubber tires do not provide protection from lightning. Golfers continue to make the same mistakes year after year. Golfers should know to seek safe shelter (clubhouse or closed metal vehicle) before the storm arrives and not return prematurely to the golf course. They should avoid isolated trees, open fields, unsafe sheds and metal poles. They should separate from each other rather than gather together. Swimmers should get out of the pool and find a safe shelter. Safe areas do not include poolsides, under awnings or under trees. A nearby closed automobile may be the safest place until the danger is gone. Applying precautions when engaging in these sporting or recreational activities will help to minimise the risk of casualties or fatalities caused by lightning.
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Affiliation(s)
- M Cherington
- Lightning Data Center, St. Anthony Hospital, Denver, Colorado, USA.
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Cohen MA. Clinical pearls: struck by lightning. Cutaneous manifestation of lightning strike ("splash"). Acad Emerg Med 2001; 8:893, 929-31. [PMID: 11535482 DOI: 10.1111/j.1553-2712.2001.tb01150.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M A Cohen
- York Hospital/Penn State University, Emergency Medicine Residency Program, York, PA 17405, USA.
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