eMedicine Specialties > Emergency Medicine > Environmental

Lightning Injuries: Differential Diagnoses & Workup

Author: Mary Ann Cooper, MD, Professor, Department of Emergency Medicine, University of Illinois at Chicago
Contributor Information and Disclosures

Updated: Jun 12, 2009

Differential Diagnoses

Electrical Injuries
Intracranial hemorrhage
Seizure
Syncope
Ventricular Fibrillation

Other Problems to Be Considered

Cardiorespiratory arrest
CNS injury
Autonomic nervous system injury
Peripheral nervous system injury
Blunt trauma
Musculoskeletal injury
Acoustic injury
Barotrauma

Workup

Laboratory Studies

  • Perform specific laboratory examinations as directed by physical findings.
  • Extensive muscle damage producing myoglobinuria is quite rare with lightning and can easily be screened with a dipstick of fresh urine. 
  • CPK is generally minimally elevated, if at all, and has no linear or direct correlation with outcome.

Imaging Studies

  • Perform imaging studies as directed by the physical findings. If a patient had loss of consciousness or presents with confusion or clouded consciousness, a noncontrast CT scan or MRI of the head is probably indicated to rule out intracranial bleeding or contusion of the brain. The vast majority of scans will be normal.
  • Routine imaging is not warranted because most lightning survivors have reasonably minimal injury.

Other Tests

  • Perform ECG as directed by physical findings. Many changes may be observed on the ECG, but the most commonly reported change is QT prolongation, which generally resolves over several months and does not commonly require treatment. The indicated treatment depends on the resulting abnormality. Unless ECG changes or cardiac-like chest pain is present, there admission for cardiac monitoring is not needed.
  • A neuropsychological battery may be indicated later if the person reports memory loss, inability to process new information, and other cognitive difficulties.

More on Lightning Injuries

Overview: Lightning Injuries
Differential Diagnoses & Workup: Lightning Injuries
Treatment & Medication: Lightning Injuries
Follow-up: Lightning Injuries
References
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References

  1. Lopez RE, Holle RL, Heitkamp TA. Lightning casualties and property damage in Colorado from 1950 to 1991 based on storm data. Weather and Forecasting. 10:114-126.

  2. Cooper MA, Andrews CJ, Holle RL. Lightning injury. In: Auerbach. Wilderness Emergencies. CV Mosby; 2006:chap3. [Full Text].

  3. Bier M, Chen W, Bodnar E, Lee RC. Biophysical injury mechanisms associated with lightning injury. NeuroRehabilitation. 2005;20(1):53-62. [Medline].

  4. Cooper MA. A fifth mechanism of lightning injury. Acad Emerg Med. Feb 2002;9(2):172-4. [Medline].

  5. Cooper MA. Lightning injuries: prognostic signs for death. Ann Emerg Med. Mar 1980;9(3):134-8. [Medline].

  6. [Guideline] Zimmermann C, Cooper MA, Holle RL. Lightning safety guidelines. Ann Emerg Med. Jun 2002;39(6):660-4. [Medline]. [Full Text].

  7. Cherington M. Closing the gap on the actual numbers of lightning casualties and deaths. Preprints, 11th Conference on Applied Climatology, Dallas, January 10-15. Boston: 1999.

  8. Andrews CJ, Cooper MA, Darveniza M. Lightning Injuries: Electrical Medical, and Legal Aspects. 1992.

  9. Andrews CJ, Darveniza M. Telephone-mediated lightning injury: an Australian survey. J Trauma. May 1989;29(5):665-71. [Medline].

  10. Cooper MA. Emergent care of lightning and electrical injuries. Semin Neurol. Sep 1995;15(3):268-78. [Medline]. [Full Text].

  11. Cooper MA, Holle R, Andrews C. Field J, ed. Electrical Current and Lightning Injury, The Textbook of Emergency Cardiovascular Care and CPR. Lippincott, Williams & Wilkins; ACLS for the Experienced Provider, AHA/ACEP; 2009:498-511.

  12. Cooper MA, Johnson SA. Cardiopulmonary resuscitation and early management of the lightning strike victim. In: Ornato JP, Peberdy MA. Cardiopulmonary Resuscitation. Humana Press; 2005.

  13. Cooper, MA. Lightning Injury Homepage. Lightning Injury. Available at www.uic.edu/labs/lightninginjury or www.uic.edu/~macooper. several articles in PDF as well as complete world bibliography on lightning injury. [Full Text].

  14. Cherington M. Spectrum of neurologic complications of lightning injuries. NeuroRehabilitation. 2005;20(1):3-8. [Medline].

  15. Cooper MA, Kotsos T, Gandhi MV. Acute Autonomic and Cardiac Effects of Simulated Lightning Strike in Rodents. Society for Academic Emergency Medicine. Atlanta, Ga: 2001.

  16. Cooper MA, Marshburn S. Lightning Strike and Electric Shock Survivors, International. NeuroRehabilitation. 2005;20(1):43-7. [Medline].

  17. Jost WH, Schonrock LM, Cherington M. Autonomic nervous system dysfunction in lightning and electrical injuries. NeuroRehabilitation. 2005;20(1):19-23. [Medline].

  18. Lightning Safety. NWS Lightning Safety. Available at http://www.lightningsafety.noaa.gov/. Accessed April 16, 2009.

  19. Marshburn S. Lightning strike and electric shock survivors, international. LSESSI. Available at www.lightning-strike.org. Accessed April 1, 2009.

  20. Primeau M, Engelstatter GH, Bares KK. Behavioral consequences of lightning and electrical injury. Semin Neurol. Sep 1995;15(3):279-85. [Medline].

  21. Yarnell PR. Neurorehabilitation of cerebral disorders following lightning and electrical trauma. NeuroRehabilitation. 2005;20(1):15-8. [Medline].

  22. Lammertse DP. Neurorehabilitation of spinal cord injuries following lightning and electrical trauma. NeuroRehabilitation. 2005;20(1):9-14. [Medline].

  23. Capelli-Schellpfeffer M. Roadblocks to return to work after electrical trauma. NeuroRehabilitation. 2005;20(1):49-52. [Medline].

  24. Holle RL, Lopez RE. A comparison of current lightning death rates in the U.S. with other locations and times. Preprints, International Conf on Lightning and Static Electricity. Sept 16-18, B. 2003;paper 103-34.

  25. National College Athletic Association. Sports Medicine Handbook 2007-08. National College Athletic Association. www.StruckbyLightning.org. 12. [Full Text].

  26. Utley M. StruckbyLightning.org. Available at www.StruckbyLightning.org. Accessed April 16, 2009.

  27. Holle RL, Lopez RE, Zimmermann C. Updated recommendations for lightning safety. Bulletin of the American Meteorological Society. 1999;80:2035-41.

  28. Holle RL, Murphy MJ, Lopez RE. Distances and times between cloud-to-ground flashes in a storm. Preprints, Intl Conf on Lightning and Static Electricity, Blackpool, UK, Royal A. 2003.

  29. Cooper MA. Myths, miracles, and mirages. Semin Neurol. Dec 1995;15(4):358-61. [Medline]. [Full Text].

  30. Primeau M. Neurorehabilitation of behavioral disorders following lightning and electrical trauma. NeuroRehabilitation. 2005;20(1):25-33. [Medline].

  31. Selvaggi G, Monstrey S, Van Landuyt K, Hamdi M, Blondeel P. Rehabilitation of burn injured patients following lightning and electrical trauma. NeuroRehabilitation. 2005;20(1):35-42. [Medline].

  32. Norman ME, Albertson D, Younge BR. Ophthalmic manifestations of lightning strike. Surv Ophthalmol. Jul-Aug 2001;46(1):19-24. [Medline].

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Further Reading

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Keywords

electrical injuries, lightning injury, lightning strike, lightning stroke, direct lightning strike, side splash lightning strike, contact voltage lightning strike, ground current effect, lightning burns, keraunoparalysis, vascular spasm, neurologic damage, autonomic instability, neurological injury, anoxic brain injury, autonomic nervous system injury, peripheral nervous system injury

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Contributor Information and Disclosures

Author

Mary Ann Cooper, MD, Professor, Department of Emergency Medicine, University of Illinois at Chicago
Mary Ann Cooper, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, American Meteorological Association, Illinois State Medical Society, National Lightning Safety Institute, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Edmond A Hooker II, MD, DrPH, FAAEM, Assistant Professor, Department of Health Services Administration, Xavier University; Associate Clinical Professor, Department of Emergency Medicine, University of Louisville; Assistant Clinical Professor, Department of Emergency Medicine, Wright State University
Edmond A Hooker II, MD, DrPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Public Health Association, Society for Academic Emergency Medicine, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

James Steven Walker, DO, MS, Clinical Professor of Surgery, Department of Surgery, University of Oklahoma Health Sciences Center
James Steven Walker, DO, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and American Osteopathic Association
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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