hearing loss, conductive deafness, tinnitus, basilar skull fx, avulsion of
the mastoid bone, burns to the external auditory canal, and peripheral
facial nerve palsy have been noted.
Numerous types of fractures and dislocations have
been reported, probably most common due to blunt trauma or severe
spasm. Muscle compartment syndromes are also reported but in general
are rare. Physeal injuries in children have been reported.
Any organ system may be injured secondary to
being thrown by the secondary concussion...all patients should be
stabilized and evaluated accordingly.
Psychiatric: "Post-electric" shock syndrome is a disorder of cognitive
and psychologic disturbances following lightning or electrical injury.
Cognitive complaints and deficits resemble those in mild to moderate
traumatic brain injury, and psychologic disturbances range from specific
phobias to major depression. Multiple somatic complaints are often
noted. Patients who have not recovered from initial effects after 3 months
are at risk for long-term sequelae and disability. A larger support group
called the Lightning Strike and Electric Shock Survivors, Int. Inc. exists.
In a review of 11 pregnant women who survived
lightning strike, there were 5 cases of fetal death in utero, abortion,
stillbirth or neonatal death. The only fetal autopsy revealed pulmonary
If the lightning strike is not witnessed, it is difficult and
confusing at times to clarify the diagnosis. Differential diagnoses include
trauma and assault, MI, CVA, seizure, subarachnoid hemorrhage and the
differential that is used for unconsciousness. The presence of typical burn
patterns, outdoor location with thunderstorm present and/or tympanic
rupture may be clues.
The major cause of death in lightning injuries is
cardiopulmonary arrest (~10-30%). Quick initial assessment and treatment
needs to be instituted ASAP. Most lightning strikes involve single victims,
however groups are sometimes involved. "Reverse triage" is applied to
multiple victims of lightning injuries; i.e. victims who appear clinically dead
following the strike should be treated before other victims who show signs
At the Scene:
Initial assessment and "reverse" triage if needed.