Lightning injuries - Revision history

Rossdonaldson1: /* Evaluation */

2023-11-15T19:20:55Z

Evaluation

← Revisión anterior		Revisión del 19:20 15 nov 2023
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	===Diagnosis===		===Diagnosis===
	*Clinical diagnosis		*Clinical diagnosis

			{{Burn thickness chart}}

	==Management==		==Management==

Bobbycarey: /* Management */

2021-03-11T05:47:52Z

Management

← Revisión anterior		Revisión del 05:47 11 mar 2021
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	==Management==		==Management==
			*Reverse triage - prolonged on-scene CPR and ACLS protocol is indicated even if there are no initial signs of life
	*Aggressive resuscitation		*Aggressive resuscitation
	**Lightning-induced [[Cardiac Arrest]] has better prognosis than CAD-induced [[Cardiac Arrest]]		**Lightning-induced [[Cardiac Arrest]] has better prognosis than CAD-induced [[Cardiac Arrest]]

Elcatracho: /* Ortho */

2021-02-13T17:58:40Z

Ortho

← Revisión anterior		Revisión del 17:58 13 feb 2021
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	===Ortho===		===Ortho===
	*[[Compartment Syndrome]] and [[rhabdomyolysis]] are unlikely due to short duration of lightning current		*[[Compartment Syndrome]] and [[rhabdomyolysis]] are unlikely due to short duration of lightning current
			*Associated with [[posterior shoulder dislocation]]

	===Special Populations===		===Special Populations===

Elcatracho: /* Prehospital Care */

2021-02-09T03:33:06Z

Prehospital Care

← Revisión anterior		Revisión del 03:33 9 feb 2021
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	===Prehospital Care===		===Prehospital Care===
	*'''Reverse triage''' = in lightning-related MCI cases, care should be delivered to patients in cardiac and respiratory arrest first		*'''Reverse triage''' = in lightning-related MCI cases, care should be delivered to patients in [[cardiac arrest\|cardiac]] and respiratory arrest first
	**Patients struck by lightning who are alive on EMS arrival will likely survive<ref name="gatewood" />		**Patients struck by lightning who are alive on EMS arrival will likely survive<ref name="gatewood" />
	*All patients should be transported, preferably to a burn center		*All patients should be transported, preferably to a burn center

Elcatracho: /* Prehospital Care */

2021-02-09T03:32:39Z

Prehospital Care

← Revisión anterior		Revisión del 03:32 9 feb 2021
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	===Prehospital Care===		===Prehospital Care===
	*'''Reverse triage''' = in lightning-related MCI cases, care should be delivered to patients in cardiac arrest first		*'''Reverse triage''' = in lightning-related MCI cases, care should be delivered to patients in cardiac and respiratory arrest first
	**Patients struck by lightning who are alive on EMS arrival will likely survive<ref name="gatewood" />		**Patients struck by lightning who are alive on EMS arrival will likely survive<ref name="gatewood" />
	*All patients should be transported, preferably to a burn center		*All patients should be transported, preferably to a burn center

ClaireLewis at 19:30, 28 September 2019

2019-09-28T19:30:42Z

← Revisión anterior		Revisión del 19:30 28 sep 2019
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	''Injuries often involve multiple organ systems<ref>Cooper M. et al. Blumenthal R: ''Lightning Injuries''. Auerbach PS ed: ''Wilderness Medicine'', 6th ed. Philadelphia: Elsevier/Mosby; 2012</ref>''		''Injuries often involve multiple organ systems<ref>Cooper M. et al. Blumenthal R: ''Lightning Injuries''. Auerbach PS ed: ''Wilderness Medicine'', 6th ed. Philadelphia: Elsevier/Mosby; 2012</ref>''
	===Cardiopulmonary===		===Cardiopulmonary===
	*Both cardiac and respiratory arrest may be present without evidence of external injury		*Both [[cardiac arrest\|cardiac]] and [[respiratory failure\|respiratory arrest]] may be present without evidence of external injury
	*Ventricular dysrhythmias, asystole, and [[QT prolongation]] most common		*[[Ventricular dysrhythmias]], [[asystole]], and [[QT prolongation]] most common
	*Although cardiac automaticity may spontaneously return, apnea may persist		*Although cardiac automaticity may spontaneously return, apnea may persist
	**Duration of apnea rather than cardiac arrest is the critical prognostic factor		**Duration of apnea rather than cardiac arrest is the critical prognostic factor
	*Myocardial infarction after lightning injury is unusual		*[[Myocardial infarction]] after lightning injury is unusual

	===Neuro===		===Neuro===
	*Symptoms are usually immediate and transient or delayed and permanent		*Symptoms are usually immediate and transient or delayed and permanent
	*[[Seizure]], LOC, confusion, amnesia, extremity paralysis		*[[Seizure]], [[syncope\|LOC]], [[confusion]], amnesia, extremity [[weakness\|paralysis]]
	*Pupillary dilation or anisocoria may occur that is unrelated to brain injury		*Pupillary dilation or anisocoria may occur that is unrelated to brain injury
	**Neuroprognostication should not be based on dilated pupils alone in setting of lightning strike<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3361158/</ref>		**Neuroprognostication should not be based on dilated pupils alone in setting of lightning strike<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3361158/</ref>
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	===Vascular===		===Vascular===
	*Vasomotor spasm may cause loss of distal pulses, coolness of extremities, loss of sensation		*Vasomotor spasm may cause loss of distal pulses, coolness of extremities, [[numbness\|loss of sensation]]
	*Keraunoparalysis - see above		*Keraunoparalysis - see above

	===Ocular===		===Ocular===
	*Cataracts may occur weeks to years after injury (must document careful eye exam in all patients)		*Cataracts may occur weeks to years after injury (must document careful eye exam in all patients)
	*Other injuries include vitreous hemorrhage, corneal abrasion, retinal detachment		*Other injuries include [[vitreous hemorrhage]], [[corneal abrasion]], [[retinal detachment]]

	===Auditory===		===Auditory===
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	*Lichtenberg figures (ferning pattern) - pathognomonic for lightning strike		*Lichtenberg figures (ferning pattern) - pathognomonic for lightning strike
	**Occur due to electron showering over the skin leading to extravasation of RBC's, not a true burn; disappear within 24hr		**Occur due to electron showering over the skin leading to extravasation of RBC's, not a true burn; disappear within 24hr
	*Flash burns		*Flash [[burns]]
	**Similar to those found in arc welders; appear as mild erythema, may involve cornea		**Similar to those found in arc welders; appear as mild erythema, may involve cornea
	*Punctate burns		*Punctate burns
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	**[[Hypotension]] is not an expected finding (i.e. suggests traumatic blood loss)		**[[Hypotension]] is not an expected finding (i.e. suggests traumatic blood loss)
	**Maintain cervical spine precautions		**Maintain cervical spine precautions
	**Targeted Temperature Management between 32 and 36 degrees Celsius shown to be neuroprotective in setting of hypoxic ischemic encephalopathy after cardiac arrest		**[[therapeutic hypothermia\|Targeted Temperature Management]] between 32 and 36 degrees Celsius shown to be neuroprotective in setting of hypoxic ischemic encephalopathy after cardiac arrest

	==Disposition==		==Disposition==
	*Admit patients with persistent muscle pain or neuro, cardiac rhythm, or vascular abnormalities		*Admit patients with persistent muscle pain or neuro, cardiac rhythm, or vascular abnormalities
	*~~Dishcarged~~ patients require follow up to assess for delayed effects of lightning injury		*Discharged patients require follow up to assess for delayed effects of lightning injury

	==See Also==		==See Also==

Spenceemmett: /* Neuro */

2019-06-15T14:31:14Z

Neuro

← Revisión anterior		Revisión del 14:31 15 jun 2019
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	*[[Seizure]], LOC, confusion, amnesia, extremity paralysis		*[[Seizure]], LOC, confusion, amnesia, extremity paralysis
	*Pupillary dilation or anisocoria may occur that is unrelated to brain injury		*Pupillary dilation or anisocoria may occur that is unrelated to brain injury
	**~~Cannot neuroprognosticate anyone for 24hrs~~ based on pupils~~{{Citation needed\|reason=Reliable source needed\|date=February 2016}}~~		**Neuroprognostication should not be based on dilated pupils alone in setting of lightning strike<ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3361158/</ref>
	*Keraunoparalysis - neuromuscular "stunning" that usually resolves spontaneously within hours		*Keraunoparalysis - neuromuscular "stunning" that usually resolves spontaneously within hours
	**Thought of as a neurologic phenomenon but actually result of arterial vasospasm from catecholamine release		**Thought of as a neurologic phenomenon but actually result of arterial vasospasm from catecholamine release

Spenceemmett: /* Disposition */

2019-06-15T14:24:48Z

Disposition

← Revisión anterior		Revisión del 14:24 15 jun 2019
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	==Disposition==		==Disposition==
	*Admit patients with persistent muscle pain or neuro, cardiac rhythm or vascular abnormalities		*Admit patients with persistent muscle pain or neuro, cardiac rhythm, or vascular abnormalities
	*Dishcarged patients require follow up to assess for delayed effects of lightning injury		*Dishcarged patients require follow up to assess for delayed effects of lightning injury

Spenceemmett: /* Work-Up */

2019-06-15T14:24:04Z

Work-Up

← Revisión anterior		Revisión del 14:24 15 jun 2019
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	==Evaluation==		==Evaluation==
	===Work-Up===		===Work-Up===
			*Exposure: complete and thorough physical exam head to toe
	*[[ECG]]		*[[ECG]]
	*CBC		*CBC
	*Chem		*Chem
	*Total CK		*Total CK
	[[UA]] - to evaluate for myoglobinuria		*[[UA]] - to evaluate for myoglobinuria
	*[[CT brain]] (for patients with [[coma]], [[altered mental status]], confusion)		*[[CT brain]] (for patients with [[coma]], [[altered mental status]], confusion)
	*Exposure: complete thorough physical exam head to toe.
	*Other imaging and workup is directed toward visible or suspected injuries		*Other imaging and workup is directed toward visible or suspected injuries

Spenceemmett: /* Work-Up */

2019-06-15T14:22:46Z

Work-Up

← Revisión anterior		Revisión del 14:22 15 jun 2019
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	==Evaluation==		==Evaluation==
	===Work-Up===		===Work-Up===
	*CBC, chem, total CK, [[UA]]
	*[[ECG]]		*[[ECG]]
			*CBC
			*Chem
			*Total CK
			[[UA]] - to evaluate for myoglobinuria
	*[[CT brain]] (for patients with [[coma]], [[altered mental status]], confusion)		*[[CT brain]] (for patients with [[coma]], [[altered mental status]], confusion)
	*Exposure: complete thorough physical exam head to toe.		*Exposure: complete thorough physical exam head to toe.