Aggressive ABC's with CPR if needed.
Standard ACLS with good ventilation.
Be aware of potential for blunt trauma injuries.
(C-spine
and
backboard)
Consider other environmental injuries...hypothermia
Transport
Note: lightning strike victims seldom have significant underlying tissue
destruction, and in contrast to other electrical injuries, fluid loading is NOT
necessary and may be harmful.
Emergency
Department
Management:
History may be poor or difficult to obtain
ABCD
and
E.
Cardiac
monitoring
and
ECG
Lab:
routine
enzymes, CBC, chemistries, UA
Xray: plain films prn, CT, others as needed.
MRI
scanning
reported
helpful.
Fluid restriction may be of benefit.
Most
require
admission
Meds: High Dose steroid use has been useful in blindness
secondary to lightning strike (controversial).
Follow-up:
Depending on injuries, subspecialty F/U or close primary
care F/U may be needed. Psychiatric problems, eye or ear problems or long-
term autonomic/neuro problems will require close following.
PREVENTION:
NO absolute safe place from lightning!!!
For group activities, develop a lightning action plan.
Know Risk Factors...see above in epidemiology.
Learn about thunderstorms and the three stages:
1.
growth
2.
maturity
3.
dissipation
Be weather wise and weather alert...watch the sky.
Flash to Bang Method
A study in Florida found the mean distance between
successive strikes from the same storm to be about 2-3 miles. Since each
storm and flash varies, if you are within 2-3 miles of a flash, the next flash
could be at your location. When you see a flash, count the seconds to the
initial bang of the thunder, and then divide the number of seconds by 5 to
