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Lightning Injuries: Treatment & Medication
Updated: Jun 12, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Prehospital Care
Any time EMS is called for an acute lightning injury, there is almost certainly an ongoing risk of lightning injury to the rescue team as the weather system continues that they should be aware of (see Deterrence/Prevention).
If there is no risk of continuing danger to the rescuers, resuscitation can occur in the field. Otherwise, safe evacuation to the unit or a substantial building is indicated. Immobilization should be considered because of risk of blunt trauma from the lightning concussion or being thrown by involuntary muscle contraction. Obviously, an alert, minimally injured patient can help decide if this is necessary. Resuscitation or supportive care can then proceed as indicated based on clinical status including advanced cardiac life support [ACLS].
Automatic external defibrillators (AEDs) have been effectively used in a number of cases. Fluid loading and alkalinization of the urine is not warranted in the vast majority of cases.
Emergency Department Care
- Routine care should be performed for any complications such as seizures, chest pain, and other symptoms.
- Reasonable reassurance and referral for continuing problems/sequelae is indicated. The vast majority of lightning survivors do not need to be admitted.
- Referral to a support group (eg, Lightning Strike and Electric Shock Survivors, International [see Patient Education for contact information]).
Consultations
Consultations are based on physical findings. Consultations may include referral to a neurologist, cardiologist, ophthalmologist, otolaryngologist, or, rarely, a burn surgeon. Later consultations may include referral to a neuropsychologist, pain specialist, or psychiatrist.
Medication
Nonsteroidal anti-inflammatory drugs (NSAIDs) for the first few days may decrease long-term neurologic damage. Although no studies have examined this, NSAIDs are the only medications available for lightning injuries at this time. Use of long-term ibuprofen, vitamin C (1 g/d), and vitamin E (400 U/d) have been shown to decrease long-term injury and scarring with electrical injury. Whether these free radical scavengers have any effect with lightning is unknown but since they are in routine doses, there is probably little harm in their use.
One report has addressed the use of high-dose steroids administered for optic neuritis caused by lightning based on the presumed efficacy originally reported for spinal cord injury treatment with high-dose steroids. No controlled studies have been performed to show whether there is any efficacy.
Nonsteroidal anti-inflammatory drugs
These are used as prophylaxis to prevent long-term neurologic damage and to treat chronic pain syndromes that may develop from sympathetic nervous system injuries caused by lightning.
Ibuprofen (Motrin, Advil, Ibuprin)
Inhibits inflammatory reactions and pain, probably by decreasing the activity of the enzyme cyclooxygenase, which results in prostaglandin synthesis.
Adult
400-600 mg PO q4-6h while symptoms persist; not to exceed 3.2 g/d
Pediatric
<6 months: Not established
6 months to 12 years: 10-20 mg/kg/d divided PO tid/qid
Start at lower end of dosing range and titrate upward to maximum of 2.4 g/d
>12 years: Administer as in adults
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; monitor PT closely (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in anticoagulation abnormalities or during anticoagulant therapy
Naproxen (Anaprox, Aleve)
Used for the relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing activity of the enzyme cyclooxygenase, which results in prostaglandin synthesis.
Adult
500 mg PO, followed by 250 mg q6-8h; not to exceed 1.25 g/d
Pediatric
<2 years: Not established
>2 years: 2.5 mg/kg/dose PO; not to exceed 10 mg/kg/d
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; monitor PT closely (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion risk acute renal failure; leukopenia occurs rarely, is transient, and usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation of drug
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
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Further Reading
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
