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Wilderness Medical Society - snowmass 2005 (Page 148)

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Wilderness Medical Society - snowmass 2005
1.
Punctate burns appear like small cigarette burns, may be clustered
and may/ may not requiring grafting
2.
Linear burns are partial thickness and tend to occur over areas of
moisture such as axilla and groin.
3.
Feathering burns are not true burns but a ferning pattern seen due
to electron showering over the skin. These are also known as
Lichtenberg figures, and resolve within hours.
4.
Thermal burns result from ignition of clothing or heating of
metallic objects such as jewelry or belts.
D.
Neurologic:
The nervous system is especially vulnerable to effects of
lightning, both central and peripheral. Up to two-thirds of seriously
injured patients have keraunoparalysis on presentation, with cold,
pulseless extremities and mottling. Many patients will have LOC and
then appear confused with anterograde amnesia for days. CNS injuries
are the most common with cerebral infarction, hypoxic encephalopathy,
basal ganglial degeneration and intracranial hematoma seen. Peripheral
nerve lesions can be seen but are reported to be less common. Autonomic
nervous system complications occur with hypertension the most
common, but cases of hypotension have also been reported. Three
categories for neurologic complications have been proposed:
1.
Immediate and transient symptoms.
a.
Nearly 75% of patients with lightning strike have a brief LOC and
80% have brief limb weakness and paresthesias.
b.
Keraunoparalysis with Lichtenberg figures seen.
2.
Immediate and prolonged or permanent.
a.
Post hypoxic-ischemic encephalopathy.
i.
Most common secondary to cardiac or respiratory arrest.
b.
Cerebral infarction.
c.
Cerebellar syndromes
3.
Possible delayed neurologic syndromes.
a.
Include motor neuron disease and movement disorders.
E.
Renal: Renal problems are reported but rare as compared to high
voltage electrical injuries. Failure secondary to hypoperfusion and
myoglobinuria [usually secondary to blunt trauma] can occur.
F.
Ophthalmic: Cataracts are noted with other electrical injuries but are
less common in lightning injuries. Macular edema and cataracts are the
most common. Reviews of a variety of neuro-ophthalmologic
complications are rare, but injuries to the entire axis have been noted
such as retinal detachments, optic nerve injury and even blindness.
G.
Otologic:
Tympanic membrane rupture is most commonly reported,
but other otologic problems such as transient vertigo, sensorineural

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