Lightning Injuries Workup

Updated: Sep 17, 2021
  • Author: Mary Ann Cooper, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Approach Considerations

Routine blood work findings in mild or moderate lightning injury are usually within reference ranges and do not contribute to patient outcome. If, for some reason, the physician believes 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 almost all 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. [128] Extensive muscle damage producing myoglobinuria is quite rare with lightning strikes and can easily be screened with a dipstick of fresh urine. [4, 29]

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 no correlation has 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.


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. [98]

Early ECG is frequently performed, but findings are often normal. Conduction abnormalities or evidence of subepicardial ischemia may be found in more severe injuries.

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, or other cognitive difficulties and can contribute to cognitive therapy. However, these tests are expensive and usually not warranted unless the patient is in litigation or is applying for accommodations for education or work.


Imaging Studies

Imaging studies should be guided by clinical suspicion based on history and physical examination. 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 owing to the possibility of head injury, intracranial bleeding, and spinal cord damage.


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 CT scan or MRI scan can evaluate brain injury. The vast majority of scans are normal. [129]