eMedicine Specialties > Trauma > Multiorgan Trauma Management

Lightning Injuries: Workup

Author: H Scott Bjerke, MD, FACS, Clinical Associate Professor, Department of Surgery, Indiana University School of Medicine, Medical Director of Trauma Services, Methodist Hospital, Clarian Health Partners, Inc
Contributor Information and Disclosures

Updated: Feb 26, 2009

Workup

Laboratory Studies

  • Routine blood work findings in mild or moderate lightning injury are usually within reference ranges. Blood work should include complete blood cell (CBC) count, creatine kinase (CK) with isoenzymes, routine urinalysis, and urine or serum myoglobin levels. Screening for myoglobin should be performed on the initial evaluation and admission to the hospital, but results are unlikely to be positive except in the most severe lightning strikes.18
  • With neurologic symptoms, the isoenzyme of CK with brain subunits (CK-BB band) may be elevated, but this has not been proven to be of major prognostic significance.
  • Patients admitted to the hospital may also benefit from blood electrolyte determinations, blood urea nitrogen (BUN), creatinine levels, and serial CK determinations.

Imaging Studies

  • In the case of blunt trauma or blast injury, plain x-rays should be considered for all contused or injured areas, including the cervical spine and chest.
  • Computed tomography (CT) scanning of the head is indicated in patients with a loss of consciousness, both to detect any injury directly caused by the lightning strike and to exclude secondary blunt trauma to the head and cerebral tissues.
  • Magnetic resonance imaging (MRI) may be helpful in cases of lightning injuries with neurologic sequelae that persist beyond the first 24 hours.19

Other Tests

  • Early electrocardiography (ECG) is frequently performed, but findings may be normal for the first 24-48 hours. Conduction abnormalities or evidence of subepicardial ischemia is common in more severe strikes.
  • Electromyography (EMG) and electroencephalography (EEG) may be helpful later in the course of injury, but they are rarely helpful in the immediate postinjury period.

More on Lightning Injuries

Overview: Lightning Injuries
Workup: Lightning Injuries
Treatment: Lightning Injuries
Follow-up: Lightning Injuries
References
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References

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Further Reading

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Keywords

lightning injuries, lightning burns, lightning, electrical injuries, electrical burns, lightning strikes, lightning flashes, lightning-related fatalities, direct strike, side flash, ground strike, flashover

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Contributor Information and Disclosures

Author

H Scott Bjerke, MD, FACS, Clinical Associate Professor, Department of Surgery, Indiana University School of Medicine, Medical Director of Trauma Services, Methodist Hospital, Clarian Health Partners, Inc
H Scott Bjerke, MD, FACS is a member of the following medical societies: American Association for the History of Medicine, American Association for the Surgery of Trauma, American College of Surgeons, Association for Academic Surgery, Eastern Association for the Surgery of Trauma, Midwest Surgical Association, National Association of EMS Physicians, Pan-Pacific Surgical Association, Royal Society of Medicine, Southwestern Surgical Congress, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Marc D Basson, MD, PhD, MBA, Professor, Chair, Department of Surgery, Michigan State University
Marc D Basson, MD, PhD, MBA is a member of the following medical societies: American College of Surgeons and American Gastroenterological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Robert L Sheridan, MD, Assistant Chief of Staff, Chief of Burn Surgery, Shriners Burns Hospital; Associate Professor of Surgery, Department of Surgery, Division of Trauma and Burns, Massachusetts General Hospital and Harvard Medical School
Robert L Sheridan, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, and American College of Surgeons
Disclosure: Nothing to disclose.

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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