Lightning Injuries Workup

  • Author: Mary Ann Cooper, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Feb 10, 2012
 

Approach Considerations

Routine blood work findings in mild or moderate lightning injury are usually within reference ranges. If the physician feels it is warranted, blood work may include complete blood cell (CBC) count, creatine kinase (CK) with isoenzymes, routine urinalysis, and urine or serum myoglobin levels, although all of these are normal in the vast majority of cases. 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.[8] Extensive muscle damage producing myoglobinuria is quite rare with lightning and can easily be screened with a dipstick of fresh urine.

Isoenzyme fraction creatine phosphokinase-BB (CPK-BB) may be elevated following lightning accidents that result in cerebral anoxia. The significance of this finding is uncertain, because a correlation has not been found between an increase in CPK-BB and the extent of brain injury.

Patients admitted to the hospital may also benefit from blood electrolyte determinations, blood urea nitrogen (BUN) testing, creatinine level evaluation, and serial CK determinations.

Electrocardiography

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. Unless ECG changes or cardiaclike chest pain is present, admission for cardiac monitoring is not needed.

Early electrocardiography 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 and electroencephalography

Electromyography and electroencephalography may be helpful later in the course of more severe injuries, but they are rarely helpful in the immediate postinjury period.

Neuropsychological battery

A neuropsychological battery may be indicated later if the person reports memory loss, an inability to process new information, and other cognitive difficulties.

Next

Imaging Studies

Routine imaging is not warranted because most lightning survivors have reasonably minimal injury. However, for the unconscious patient, the threshold for imaging should be low due to the possibility of head injury and intracranial bleeding.

Radiography

In the case of blunt trauma or blast injury, plain radiographs should be considered for all contused or injured areas, including the cervical spine and chest.

CT scanning and MRI

If a patient had loss of consciousness or presents with confusion or clouded consciousness, a noncontrast computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of the head is probably indicated to rule out intracranial bleeding or contusion of the brain. The vast majority of scans will be normal.[73]

Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Mary Ann Cooper, MD  Professor Emerita, 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 Meteorological Association, and National Lightning Safety Institute

Disclosure: vaisala None None

Coauthor(s)

Richard F Edlich, MD, PhD, FACS, FASPS, FACEP  Distinguished Professor Emeritus of Plastic Surgery, Biomedical Engineering and Emergency Medicine, University of Virginia Health Care System

Richard F Edlich, MD, PhD, FACS, FASPS, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Association of Plastic Surgeons, American Burn Association, American College of Emergency Physicians, American College of Surgeons, American Society of Plastic and Reconstructive Surgery, American Spinal Injury Association, American Surgical Association, American Trauma Society, Plastic Surgery Research Council, Society of University Surgeons, and Surgical Infection Society

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

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

Additional Contributors

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: Alpha Omega Alpha, American College of Surgeons, American Gastroenterological Association, Phi Beta Kappa, and Sigma Xi

Disclosure: Nothing to disclose.

H Scott Bjerke, MD, FACS Clinical Associate Professor, Department of Surgery, University of Missouri-Kansas City School of Medicine; Medical Director of Trauma Services, Research Medical Center; Clinical Associate Professor, Department of Surgery, Indiana University School of Medicine

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, andWilderness Medical Society

Disclosure: Nothing to disclose.

David B Drake, MD, FACS Associate Professor, Department of Plastic Surgery, Medical Director, DeCamp Burn and Wound Center, Program Director, Hand Fellowship, University of Virginia School of Medicine

David B Drake, MD, FACS is a member of the following medical societies: American Association for Hand Surgery, American Burn Association, American College of Surgeons, American Society for Reconstructive Microsurgery, American Society of Plastic and Reconstructive Surgery, Association for Surgical Education, Southeastern Society of Plastic and Reconstructive Surgeons, and Southern Medical Association

Disclosure: Nothing to disclose.

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

Edmond A Hooker II, MD, DrPH, FAAEM Assistant Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine

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.

William B Long III, MD, FACS, FASTS President, Trauma Specialists, LLP; Legacy Emanuel Trauma Center, Legacy Emanuel Hospital, Portland, Oregon

William B Long III, MD, FACS, FASTS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Chest Physicians, American College of Surgeons, American Thoracic Society, American Trauma Society, and Society of Thoracic Surgeons

Disclosure: Nothing to disclose.

Dennis P Orgill, MD, PhD Professor of Surgery, Harvard Medical School; Associate Chief of Plastic Surgery, Brigham and Women's Hospital

Dennis P Orgill, MD, PhD is a member of the following medical societies: American Medical Association, American Society for Reconstructive Microsurgery, Massachusetts Medical Society, and Plastic Surgery Research Council

Disclosure: Kinetic Concepts, Inc. Grant/research funds Principle Investigator; Brigham and Women's Hospital Royalty None; Kinetic Concepts, Inc. Expert Witness None

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.

Wayne Karl Stadelmann, MD Stadelmann Plastic Surgery, PC

Wayne Karl Stadelmann, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Society of Plastic Surgeons, New Hampshire Medical Society, Northeastern Society of Plastic Surgeons, and Phi Beta Kappa

Disclosure: Nothing to disclose

Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

Lars M Vistnes, MD, FRCSC, FACS Professor of Surgery, Emeritus, Stanford University Medical Center

Lars M Vistnes, MD, FRCSC, FACS is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

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.

References

  1. Centers for Disease Control and Prevention. Lightning-associated deaths-United States, 1980-1995. Morbidity Mortality Weekly Reports. 391-394. Washington D.C: Centers for Disease Control and Prevention; 1998.

  2. Holle RL, López RE, Howard KW, Vavrek J, Allsopp J. Safety in the presence of lightning. Semin Neurol. Dec 1995;15(4):375-80. [Medline].

  3. Krider EP, Uman MA. Cloud-to-ground lightning: mechanisms of damage and methods of protection. Semin Neurol. Sep 1995;15(3):227-32. [Medline].

  4. MacGorman BR, Maier MW, Rust WD. Lightning strike density for the contiguous United States from thunder storm duration records Washington DC. Washington D.C: US Nuclear Regulatory Commission; 1984.

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

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

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

  8. Edlich RF, Farinholt HM, Winters KL, Britt LD, Long WB 3rd. Modern concepts of treatment and prevention of lightning injuries. J Long Term Eff Med Implants. 2005;15(2):185-96. [Medline].

  9. Lifschultz BD, Donoghue ER. Deaths caused by lightning. J Forensic Sci. Mar 1993;38(2):353-8. [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. Cooper MA. Lightning injuries: prognostic signs for death. Ann Emerg Med. Mar 1980;9(3):134-8. [Medline].

  15. Lichtenberg R, Dries D, Ward K, Marshall W, Scanlon P. Cardiovascular effects of lightning strikes. J Am Coll Cardiol. Feb 1993;21(2):531-6. [Medline].

  16. Whitcomb D, Martinez JA, Daberkow D. Lightning injuries. South Med J. Nov 2002;95(11):1331-4. [Medline].

  17. Fish RM. Electric injury, part III: cardiac monitoring indications, the pregnant patient, and lightning. J Emerg Med. Feb 2000;18(2):181-7. [Medline].

  18. Offiah C, Heran M, Graeb D. Lightning strike: a rare cause of bilateral ossicular disruption. AJNR Am J Neuroradiol. May 2007;28(5):974-5. [Medline]. [Full Text].

  19. Miller SF. The long-term consequences of lightning injuries. Muehlberger T, Vogt PM, Munster AM, (Burns 2001;27:829-33). Burns. Feb 2003;29(1):97. [Medline].

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

  21. Janus TJ, Barrash J. Neurologic and neurobehavioral effects of electric and lightning injuries. J Burn Care Rehabil. Sep-Oct 1996;17(5):409-15. [Medline].

  22. Cherington M. Neurologic manifestations of lightning strikes. Neurology. Jan 28 2003;60(2):182-5. [Medline].

  23. Montalto M, Ancarani F, Manna R, Gasbarrini G. Globus pharyngis: was it a stroke of lightning?. Am J Gastroenterol. Apr 2003;98(4):938-9. [Medline].

  24. Kilbas Z, Akin M, Gorgulu S, Mentes O, Ozturk E, Kozak O, et al. Lightning strike: an unusual etiology of gastric perforation. Am J Emerg Med. Oct 2008;26(8):966.e5-7. [Medline].

  25. Aslan S, Aydinli B, Ocak T, Akcay M. Lightning: an unusual etiology of gastrointestinal perforation. Burns. Mar 2005;31(2):237-9. [Medline].

  26. Abrahamson J, Dinniss J. Ball lightning caused by oxidation of nanoparticle networks from normal lightning strikes on soil. Nature. Feb 3 2000;403(6769):519-21. [Medline].

  27. Cherington M, Yarnell PR, Lane J, Anderson L, Lines G. Lightning-induced injury on an airplane: coronal discharge and ball lightning. J Trauma. Mar 2002;52(3):579-81. [Medline].

  28. Sinha AK. Lightning-induced myocardial injury. A case report with management. Angiology. May 1985;36(5):327-31. [Medline].

  29. Blount BW. Lightning injuries. Am Fam Physician. Aug 1990;42(2):405-15. [Medline].

  30. Ohashi M, Kitagawa N, Ishikawa T. Lightning injury caused by discharges accompanying flashovers--a clinical and experimental study of death and survival. Burns Incl Therm Inj. Oct 1986;12(7):496-501. [Medline].

  31. Blumenthal R, Jandrell IR, West NJ. Does a Sixth Mechanism Exist to Explain Lightning Injuries?: Investigating a Possible New Injury Mechanism to Determine the Cause of Injuries Related to Close Lightning Flashes. Am J Forensic Med Pathol. Sep 26 2011;[Medline].

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

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

  34. Cooper MA, Holle RL. Mechanisms of lightning injury should affect lightning safety messages. 3rd International Lightning Meteorology Conference, Orlando, Florida; 2010: [Full Text].

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

  36. National Collegiate Athletic Association. NCAA Sports Medicine Handbook 2008-09. National Collegiate Athletic Association. Available at http://www.ncaa.org/wps/wcm/connect/873cf8804e0db2a5ac9cfc1ad6fc8b25/SMH0708_final.pdf?MOD=AJPERES. Accessed November 14, 2011.

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

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

  39. 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.

  40. National Oceanic and Atmospheric Administration. Lightning Safety Awareness Week. www.nws.noaa.gov. Available at http://www.lightningsafety.noaa.gov/. Accessed November 14, 2011.

  41. 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.

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

  43. Holle RL. Annual rates of lightning fatalities by country. 20th International Lightning Detection Conference; 2008. Available at http://www.vaisala.com/Vaisala%20Documents/Scientific%20papers/Annual_rates_of_lightning_fatalities_by_country.pdf. Accessed November 14, 2011.

  44. Adekoya N, Nolte KB. Struck-by-lightning deaths in the United States. J Environ Health. May 2005;67(9):45-50, 58. [Medline].

  45. Cherington M, et al. Closing the gap on the actual numbers of lightning casualties and deaths. 11th Conference on Applied Climatology, Dallas, January 10-15, 1999: American Meteorological Society.

  46. Ashley W, Gilson C. A reassessment of U.S. lightning mortality. Bulletin of the American Meteorological Society; 2009. 1501-18.

  47. 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.

  48. Cooper MA, Kadir MZA. Lightning Injury Continues to be a Public Health Threat Internationally. 3rd International Lightning Meteorology Conference; 2010. Available at http://www.vaisala.com/Vaisala%20Documents/Scientific%20papers/5.Cooper,%20Zainal.pdf. Accessed November 14, 2011.

  49. Holle RL. Lightning–caused deaths and injuries in and near dwellings and other buildings. 4th Conference on the Meteorological Applications of Lightning Data; Phoenix, Arizona: American Meteorological Society; 2009.

  50. Cherington M, Krider EP, Yarnell PR, Breed DW. A bolt from the blue: lightning strike to the head. Neurology. Mar 1997;48(3):683-6. [Medline].

  51. Cherington M, Kurtzman R, Krider EP, Yarnell PR. Mountain medical mystery. Unwitnessed death of a healthy young man, caused by lightning. Am J Forensic Med Pathol. Sep 2001;22(3):296-8. [Medline].

  52. Blumenthal R. When thunder roars -- go indoors!. S Afr Med J. Jan 2006;96(1):38-9. [Medline].

  53. Gluncic I, Roje Z, Gluncic V, Poljak K. Ear injuries caused by lightning: report of 18 cases. J Laryngol Otol. Jan 2001;115(1):4-8. [Medline].

  54. Ramati A, Pliskin NH, Keedy S, et al. Alteration in functional brain systems after electrical injury. J Neurotrauma. Oct 2009;26(10):1815-22. [Medline].

  55. Ramati A, Rubin LH, Wicklund A, et al. Psychiatric morbidity following electrical injury and its effects on cognitive functioning. Gen Hosp Psychiatry. Jul-Aug 2009;31(4):360-6. [Medline].

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

  57. 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.

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

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

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

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

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

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

  64. Cherington M, McDonough G, Olson S, Russon R, Yarnell PR. Lichtenberg figures and lightning: case reports and review of the literature. Cutis. Aug 2007;80(2):141-3. [Medline].

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

  66. 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].

  67. Bartholome CW, Jacoby WD, Ramchand SC. Cutaneous manifestations of lightning injury. Arch Dermatol. Nov 1975;111(11):1466-8. [Medline].

  68. Cooper MA. Medical Aspects of Lightning Injury in the Developing World: Keynote address. International Conference on Lightning Protection, Kathmandu, Nepal Oct 12-14, 2011.

  69. ten Duis HJ, Klasen HJ, Nijsten MW, Pietronero L. Superficial lightning injuries--their "fractal" shape and origin. Burns Incl Therm Inj. Apr 1987;13(2):141-6. [Medline].

  70. Noel LP, Clarke WN, Addison D. Ocular complications of lightning. J Pediatr Ophthalmol Strabismus. Jul-Aug 1980;17(4):245-6. [Medline].

  71. Shapiro MB. Lightning cataracts. Wis Med J. Dec 1984;83(12):23-4. [Medline].

  72. Cankaya H, Egeli E, Evliyaoglu Z. Hearing loss caused by lightning strike: case report and review of the literature. J Otolaryngol. Jun 2002;31(3):181-3. [Medline].

  73. Freeman CB, Goyal M, Bourque PR. MR imaging findings in delayed reversible myelopathy from lightning strike. AJNR Am J Neuroradiol. May 2004;25(5):851-3. [Medline]. [Full Text].

  74. Marcus MA, Thijs N, Meulemans AI. A prolonged but successful resuscitation of a patient struck by lightning. Eur J Emerg Med. Dec 1994;1(4):199-202. [Medline].

  75. Fatovich DM. Electric shock in pregnancy. J Emerg Med. Mar-Apr 1993;11(2):175-7. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.