Lightning injury
| Lightning injury | |
|---|---|
| Other names | Effects of lightning |
 | |
| Multiple lightning bolts strike a populated area. | |
| Specialty | Emergency medicine |
| Usual onset | 20 to 45 year old males[1] |
| Types | Direct strikes, side splash, contact injury, ground current[1] |
| Causes | Lightning strike[1] |
| Diagnostic method | Based on history of the injury and examination[1] |
| Prevention | Avoiding the outdoors during a thunderstorm[2] |
| Treatment | CPR, artificial ventilation[1] |
| Frequency | 240,000 a year[1] |
| Deaths | 24,000 a year[1] |
Lightning injuries are injuries caused by a lightning strike.[3] Initial symptoms may include heart asystole and respiratory arrest.[1] While the asystole may resolve spontaneously fairly rapidly, the respiratory arrest is typically more prolonged.[1] Other symptoms may include burns and blunt injuries.[1] Of those who survive about 75% have ongoing health problems as a result, such as cataracts and hearing loss.[1] If death occurs it is typically from either a heart arrhythmia or respiratory failure.[1]
Lighting injuries are divided into direct strikes, side splash, contact injury, and ground current.[1] Ground current make up about half of cases and occurs when the lightning strikes nearby and travels to the person through the ground.[1] Side splash makes up about a third of cases and occurs when lightning strikes nearby and jumps through the air to the person.[1] Contact injury occurs when the person is touching the object that is hit well direct strikes make up about 5% of injuries.[1] The mechanism of the injuries may include electrical injury, burns from heat, and mechanical trauma.[1] Diagnosis is typically based on history of the injury and examination.[1]
Prevention includes avoiding being outdoors during a thunderstorm.[2] If avoiding being outdoors is unavoidable crouching low is recommended.[2] When indoors the use of devices connected to electrical outlets and contact with water is not recommended.[2] Among those who appear in cardiac arrest and have no central pulse, cardiopulmonary resuscitation (CPR) should be started.[1] In those who have a central pulse but are not breathing artificial ventilation, such as mouth to mouth, is recommended.[1][4]
It is estimated that lightning injuries occur 240,000 times a year with 24,000 deaths.[1] Among pregnant women who are hit by lightning, the death of the baby occurs in about half.[1] In the United States about 1 in 10,000 people is hit by lightning during their lifetime.[1] Males are affected 4 times more often than females.[1] The age group most commonly affected is 20 to 45 years old.[1]
Contents
Signs and symptom[edit]
Common injuries caused by lightning include: muscle pains, broken bones, cardiac arrest, confusion, hearing loss, and seizures.[3] Loss of consciousness is very common immediately after a strike.[5]
Lightning burns are a skin condition, a type of electrical burn following a lightning strike. They are characterized by a unique pattern of skin lesions. Alternative names for them include "keraunographic markings", "feathering", "ferning", "Lichtenberg figures",[6][7] "lightning flowers" or "lightning trees".[8] The marks are formed when capillaries beneath the skin rupture due to the electrical discharge and they usually appear "within hours" of the strike though they tend to disappear within a few days. They also generally occur on the upper body.[8]
A bolt of lightning can reach temperatures approaching 28,000° Celsius (50,000° Fahrenheit) in a split second. This is about five times hotter than the surface of the sun.[9] Spectacular and unconventional lightning damage can be caused by thermal effects of lightning. Hot lightning (high-current lightning) which lasts for more than a second can deposit immense energy, melting or carbonizing large objects. One such example is the destruction of the basement insulator of the 250 m (820 ft) high central mast of the Orlunda radio transmitter, which led to its collapse. The intense heat generated by a lightning strike can burn tissue, and cause lung damage, and the chest can be damaged by the mechanical force of rapidly expanding heated air.[3]
Just as heat can cause expanding air in the lungs, the explosive shock wave created by lightning (the cause of thunder) can cause concussive and hearing damage at extremely close range. Other physical injury can be caused by objects damaged or thrown by the lightning strike. For example, lightning striking a nearby tree may vaporize sap, and the steam explosion often causes bark and wood fragments to be explosively ejected.
Diagnosis[edit]
Diagnosis is typically based on history of the injury and examination.[1]
Types[edit]
Lightning can strike or injure humans in four different ways:
- Direct strike
- 'Splash' from nearby objects struck
- Ground strike near the person causing a difference of potential in the ground itself (due to resistance to current in the Earth), amounting to several thousand volts per foot, depending upon the composition of the earth that makes up the ground at that location (sand being a fair insulator and wet, salty and spongy earth being more conductive).
- Electromagnetic pulse from close strikes – especially during positive lightning discharges
In a direct hit, the electrical charge strikes the person first. Splash hits occur when lightning jumps to a person (lower resistance path) from a nearby object that has more resistance, striking the person on its way to the ground. In ground strikes, the bolt lands near the person and is conducted by a connection to the ground (usually the feet), due to the voltage gradient in the earth. This can still cause substantial injury.
Prevention[edit]
Prevention includes avoiding being outdoors during a thunderstorm.[2] If avoiding being outdoors is unavoidable crouching low is recommended.[2] When indoors the use of devices connected to electrical outlets and contact with water is not recommended.[2]
Treatment[edit]
Reported mortality rates range from 10–30 percent, depending on the source of data. Most people who are struck by lightning live to tell the story, but many suffer from long term injury or disability.[10] The treatment of lightning injuries is keraunomedicine.[11][12]
Immediate[edit]
The most critical injuries are cardiac arrest and respiratory failure. This will often require prompt emergency care.[5] It is safe to provide care immediately, as the affected person will not retain an electrical charge after the lightning has struck.[4]
Many people who are unconscious and appear lifeless, die of suffocation[citation needed]. Chances of survival may be increased if cardiopulmonary resuscitation (CPR) is started immediately, and continued without interruption until the brainstem recovers.[13]
Long-term[edit]
A complete physical examination by paramedics or physicians may reveal ruptured eardrums. Ocular cataracts may later develop, sometimes more than a year after an otherwise uneventful recovery. Long-term injuries are usually neurological in nature, including memory deficit, sleep disturbance, chronic pain, and chronic dizziness.[14]
Epidemiology[edit]
It is estimated that lightning injuries occur 240,000 times a year with 24,000 deaths.[1] Among pregnant women who are hit by lightning, the death of the baby occurs in about half.[1] In the United States about 1 in 10,000 people is hit by lightning during their lifetime.[1] Males are affected 4 times more often than females.[1] The age group most commonly affected is 20 to 45 years old.[1]
References[edit]
- ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae Jensen, JD; Vincent, AL (January 2019). "Lightning Injuries". StatPearls. PMID 28722949.
- ^ a b c d e f g "Lightning Safety Tips". CDC. 23 January 2019. Retrieved 11 November 2019.
- ^ a b c Mallinson, T (2013). "Understanding the correct assessment and management of lightning injuries". Journal of Paramedic Practice. 5 (4): 196–201. doi:10.12968/jpar.2013.5.4.196. Retrieved 2019-06-11.
- ^ a b "First Aid Recommendations Lightning". CDC. 23 January 2019. Retrieved 11 November 2019.
- ^ a b Mallinson, T (2010). "Lightning Injuries". Focus on First Aid (16): 15–16. Archived from the original on 11 March 2012. Retrieved 2010-09-30.
- ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.
- ^ Mallinson, T (2010). "Lightning Injuries". Focus on First Aid (16): 15–16. Archived from the original on 2011-11-26. Retrieved 2010-09-30.
- ^ a b "How do you recover from being struck by lightning?". Retrieved 9 August 2013.
- ^ "Sun Fact Sheet". nssdc.gsfc.nasa.gov. Retrieved 2018-07-26.
- ^ Jedick, Rocky. "Flight Surgeon Busts Lightning Myths". AFMS. Retrieved 6 October 2012.
- ^ Chris Andrews - JOLR Archived 2007-09-29 at the Wayback Machine
- ^ Andrews, C. J., 1995: Keraunomedicine: A discipline come of age. Annals of Emergency Medicine, 25, 543-545. This is possibly the first use of the term.
- ^ Dayton, L (1993). "Science: Secrets of a bolt from the blue", New Scientist, 18 December 1993.
- ^ NOAA Lightning Safety Facts
External links[edit]
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