Lightning injuries is an electrical injury caused by exposure to a sequential stream of atmospheric electricity discharges. Leads to the development of arrhythmia, neurological disorders, skin burns. Possible ruptures of internal organs, loss of vision or hearing. The clinical picture of the lesion depends on which structure was affected by the traumatic factor. Pathology is diagnosed on the basis of anamnesis and characteristic signs of electric shock (lightning signs). There is no specific treatment. Therapy is prescribed in accordance with the existing disorders.
T75.0 Lightning injuries
Lightning injuries is the effect of a lightning electrical discharge, leading to severe multi–system damage of a thermal and mechanical nature. According to modern statistics, from 6 to 24 thousand people die from lightning injuries every year. Another 10 times more people become disabled. The probability of becoming a “victim” of a lightning discharge during a person’s lifetime is 1:10,000 – 1:300,000. The largest number of cases of lightning damage is recorded in regions with high thunderstorm activity − North America, Africa, India.
Lightning injuries occur when a person is in the place of its possible formation. Most cases occur during a thunderstorm, but there are situations when a discharge appears from a clear sky. There are fireballs that have the ability to move in the air for a long time, to penetrate into people’s homes. Among the factors that increase the likelihood of an atmospheric electric shock are:
- Being in an open space. It is known that lightning often hits the most elevated areas of the terrain. Therefore, a natural discharge usually occurs if a person is in a field, on the roof of a high-rise building or on the surface of a reservoir.
- Contact with a conductive surface. Lightning damage can occur indirectly if a person holds onto a downpipe, a metal fence, or a telephone wire. A discharge that hits one part of the structure spreads over its entire surface and affects the victim.
- Stay close to the impact site. Lightning, when it hits the ground, forms an ascending streamer, i.e. it bounces off the surface at various angles. Such discharges are considered relatively low–energy, but the current in them still reaches several thousand amperes, and the temperature is 20-25 000 ° C.
The striking factors of lightning include a powerful electric discharge, high temperature and a shock wave, which is formed when the air is instantly heated to 30,000 ° C. Under the influence of electricity, first of all, there is a violation of the phases of polarization and repolarization of the myocardium, ischemia of cardiomyocytes, their transition to anaerobic glycolysis.
When a current passes through the central nervous system, the permeability of cell membranes changes. There is a denaturation of proteins and a change in the electrolyte balance. Lightning damage leads to the formation of foci of ischemia in the brain, disruption of neuromuscular conduction. Massive burns and internal injuries in victims are not always detected. Sometimes there are only “lightning signs” on the body.
Lightning damage is divided by the mechanism of occurrence (direct, indirect, reflected) or by the type of electric discharge (linear, ball, step voltage). These types of division allow you to pre-evaluate the strength and nature of the traumatic effect. The most common classification is considered to be based on the predominant lesion of a particular system of the body:
- Lightning injuries with heart damage. The discharge passing through the coronary tissues disrupts the work of the conducting system. Due to this, the victim develops arrhythmia, coronary artery spasm, myocardial infarction. If the stroke occurs during the repolarization phase, there is a high probability of ventricular fibrillation or asystole.
- Damage to the central nervous system. The passage of the discharge through the nerve structures causes paresis, paralysis, strokes. In some cases, lightning damage is complicated by vasogenic edema of the brain, hearing or vision impairment of the central type. In the future, the formation of post-traumatic myelopathy is possible.
- Blunt trauma. Ruptures of the lung, intestines, pneumothorax are diagnosed. To exclude such damage, victims of atmospheric electricity shocks should be hospitalized and examined even in the absence of visible damage.
- Burn injury. The area of burns varies from a few centimeters to 70-100% of the body surface. Patients with massive injuries are usually in a state of shock and need to start appropriate treatment immediately. The mortality rate among the victims with volumetric thermoelectric damage is the highest.
The symptoms vary depending on the existing injuries. With the development of atrial fibrillation, there is a decrease in blood pressure, the victim complains of a feeling of palpitation, a general deterioration in well-being. There may be pain in the heart, mixed shortness of breath. If the conductive pathways are affected, a conduction blockade is formed, the nodes of automation — bradycardia up to 35-40 beats per minute.
Lightning damage, in which damage to the central nervous system prevails, causes coordination disorders, disorientation in time and space. A number of victims develop a weakening of cognitive abilities after a while, symptoms of mental retardation are revealed. Sometimes phobias are formed associated with being outside during bad weather.
Due to the short-term effect of the traumatic factor, burns are usually superficial. Other symptoms are determined by the type and function of the damaged organ. With ruptures of the lung, cyanosis, shortness of breath, hemoptysis are noted; with intestinal injuries, abdominal pain, signs of internal bleeding. A shock reaction may develop.
Lightning damage is accompanied by cardiovascular complications in 46% of cases. Most often, disturbances in the work of the heart occur immediately after injury. Directly at the scene of the accident, some victims experience ventricular fibrillation or asystole, which is accompanied by the onset of clinical death. Severe arrhythmia or myocardial infarction may develop a few days after being exposed to the discharge.
Some neurological complications are found in 85% of people hospitalized for high-energy atmospheric electricity shock. As a result of the formation of an ischemic focus in the brain, paresis and paralysis occur, the cognitive abilities of the victim decrease, vital functions are disrupted. There are cases of hypertension due to hypertonicity of the sympathetic nervous system.
In 5-6% of cases, a lightning injuries leads to retinopathy and cataract. This is due to the high sensitivity of the retinal pigment epithelium to thermal and electrical effects. As a result of protein coagulation and impaired nutrition of the lens, the latter becomes cloudy and loses its functional purpose. As a rule, vision is impaired in the eye that was closer to the point of entry of electricity.
Lightning damage is diagnosed by an employee of the ambulance team who arrived at the scene. In the presence of eyewitnesses and characteristic symptoms, diagnosis is not difficult. Internal injuries are detected by diagnostic doctors in the hospital’s reception department. Mandatory examinations include:
- Physical examination. The patient has symptoms corresponding to the clinical picture of the electrical injury. Lichtenberg figures may be present on the body, resembling a lightning bolt, but sometimes they occur only after a few hours. In general, the clinical picture is very variable and depends on the presence of certain internal disorders.
- Laboratory examination. With the development of myocardial infarction, the level of blood troponin increases, anemia develops with internal bleeding. Massive burns are accompanied by an increase in hematocrit, blood loss — a decrease in the amount of hemoglobin and shaped elements. An increase in potassium concentration and other electrolyte disturbances are possible.
- Instrumental examination. The ECG may show elevation of the ST segment, absence of P teeth, and fibrillation waves. The level of free fluid in the abdominal cavity indicates the presence of bleeding. Chest x-ray allows you to detect rib fractures, lung ruptures. CT brain may show foci of reduced density in the cerebral tissue.
If consciousness is preserved, the victim is laid on his back, carefully examined, the damage is covered with a sterile bandage. In the absence of consciousness, a person should lie on his side. Cardiac arrest requires the immediate start of cardiopulmonary resuscitation. Transportation is carried out by sanitary transport. If necessary, analgesics, sedatives, vasopressors are administered.
Any electrical injury is treated in a hospital. Hospitalization in the intensive care unit is recommended, regardless of the condition of the person who suffered a lightning injuries. Here, the resuscitator has the opportunity to continuously monitor the work of the heart and timely stop complications that are accompanied by electric shock. You may need to consult a surgeon, therapist, neurologist.
Infusion therapy is prescribed to restore the volume of circulating blood and normalize hematocrit. In the presence of arrhythmia, the patient receives antiarrhythmic drugs. If they are ineffective, an electrical cardioversion is performed. Neurological patients need to take nootropic and vascular drugs, antihypoxants. In addition, symptomatic treatment, anesthesia, and, if necessary, drug sedation are indicated.
If the victim has internal injuries, they are sutured in the operating room. The intervention is carried out in an open or endoscopic way. The choice of method depends on the prevalence of injury and the technical equipment of the clinic. If WPW syndrome occurs, radiofrequency ablation is indicated. During the operation, electrodes are inserted through the femoral vessels into the heart, with the help of which the surgeon performs cauterization of the arrhythmogenic site. After that, the heart rate is restored.
Prognosis and prevention
In the absence of significant damage to the heart and brain, the prognosis for life is favorable. Severe heart attacks and strokes end fatally in 30-35% of cases. Brain death is accompanied by the emergence of a vegetative state when the body continues to live with the support of medical equipment, but the brain does not function. Such patients remain viable for a long time, but have no chance of restoring consciousness.
Specific preventive measures that completely exclude the possibility of lightning damage have not been developed. In case of a thunderstorm, it is not recommended to leave the house, use wireless communication methods, hold on to metal objects. It is permissible to leave the shelter no earlier than 30 minutes after the end of bad weather. When a ball lightning appears, it is impossible to perform drastic actions.