Lightning damage

A lightning strike to a person can cause cardiac arrest, loss of consciousness, and temporary or permanent neurological impairment. Severe burns and damage to internal organs are rare. The diagnosis is clinical. The examination includes ECG cardiac monitoring. Treatment is supportive.

In the US, lightning strikes kill 50-75 people every year, and several times more people are injured. Lightning most often strikes tall objects. The strike can be direct, directly to the victim, or indirect, through the ground or nearby objects. Lightning can also penetrate from an outdoor electrical network to an electrical device located in the house, or a telephone network. The force of the strike can throw the victim several meters.

Although lightning contains a large amount of energy, its effects are extremely short-lived (1/10,000 to 1/1000 s). Because of this, lightning rarely, if ever, causes serious skin damage and, in rare cases, rhabdomyolysis or serious damage to internal organs, unlike artificial high-voltage sources. Occasionally, victims may experience intracranial hemorrhage.

Lightning Damage Symptoms

An electrical discharge can disrupt the functioning of the heart, causing asystole or various types of arrhythmia, the brain, with loss of consciousness, stunning or amnesia.

Lightning strikes may cause paralysis of the limbs, spotting, coldness of the skin, and loss of pulse in the lower and sometimes upper limbs with motor and sensory impairment. The cause is instability of the sympathetic nervous system. Paralysis is typical of lightning injuries and usually resolves within a few hours, although some degree of residual paresis may remain. Other signs of lightning strikes may include minor skin burns, with a punctate or branching pattern, perforation of the eardrum, and cataracts. Neurological symptoms may include confusion, cognitive deficits, and peripheral neuropathy. Neuropsychological problems (eg, sleep disturbances, anxiety) are also possible. The most common causes of death after lightning strikes are cardiac and respiratory arrest. Cognitive deficits, pain syndromes, and sympathetic nervous system damage are the most common late effects.

Diagnosis and treatment of lightning damage

Lightning strike is obvious in many cases, but it should also be suspected when people with amnesia or unconsciousness are found during or after a hurricane or storm. Cardiopulmonary resuscitation is started if the heart and respiratory system have stopped. All patients are hospitalized, an ECG is taken, and cardiac monitoring is started. QT prolongation may occur, and arrhythmias sometimes occur after 24 hours. Patients with chest pain, ECG changes, or altered mental status should have cardiac enzymes assessed. Patients with initially altered mental status or with later deterioration, with central cerebral neurologic symptoms, should have CT or MRI.

Supportive care is given. Fluids are usually restricted to minimize the risk of cerebral edema.

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Preventing Lightning Damage

To prevent lightning strikes, it is necessary to follow safety rules, know the weather forecast, have an escape plan that includes evacuation to a safer place, and have enough time to do so. If thunder is heard, or the interval between the sound of thunder and the flash is <30 s, people should immediately seek shelter and stay there for at least 30 minutes after the last lightning or thunder. Large habitable buildings or closed vehicles are the safest. When indoors during a thunderstorm, people should avoid touching water pipes and electrical appliances, stay away from windows and doors, and do not use landline phones or a computer. If sheltering indoors is not possible during a thunderstorm, it is necessary to avoid high places, tall objects, open spaces, and water.