Sunday, December 4, 2011

Lightning Safety

Great article in Emergency Medicine, Vol. 43, No. 10 October 2011.

Emergency care:
1. CPR - Compression, Airway, Breathing - if victim unresponsive
2. As long as victim is breathing a care survey of the entire body must be done and a history from any witnesses must be taken.
3. Exam must include eyes, ears (ear drum rupture is common, bleeding in the ear), extremities (pulses, sensation, cold/clammy), abdomen, neurologic exam, look for burns.

"Lightning causes an estimated 50 to 300 deaths per year and approximately five times as many nonlethal injuries1,2; however, injuries and deaths due to lightning are believed to be underreported."

"Lightning generates intense heat around it, rapidly heating the air to 20,000°C, which is three times the  temperature of the surface of the sun. This rapid heating generates a supersonic shock wave that decays to an acoustic wave heard as thunder."

"Lightning produces injury and death by multiple mechanisms.6"
Electrical effect, direct strike, splash mechanism, contact injury, concussive force

"the victim of a lightning strike is unlikely to die since cardiac activity will resume spontaneously. Furthermore, when first examined, the patient may be in cardiac arrest with ventricular fibrillation."

"Telltale signs of lightning injury include an arborealtype burn (ie, Lichtenberg figures), tympanic membrane
rupture, and disheveled appearance of the patient (including clothing that is blasted apart). The patient is
also likely to be confused or amnestic to prior events."

"Recommended laboratory tests include electrolyte measurement, assessment of renal function, complete
blood count, and cardiac enzyme studies, including creatine kinase and troponin assays. ECG is mandatory,
as is cardiac monitoring. The decision to order radiologic evaluation depends on the patient’s presentation and the physician’s assessment. CT of the head may be warranted in patients with altered mental status. Further CT scans may be indicated."

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