Lightning Injuries

GENERAL INFORMATION:

What are lightning injuries?

• Lightning injuries occur when a person gets struck or hit by lightning. Lightning is a strong electrical charge that is usually seen as a flash of light in a thunderstorm. The electrical power, heat, and strong force the lightning produces can harm people, animals, and objects. Lightning injuries are more likely to happen between the months of May and September (summer season). They are most common in rural areas and open fields than in cities.
  
  
• When lightning hits your body, the current flows and passes for a short time through tissues. These tissues include nerves, blood vessels, muscles, tendons, ligaments, bones, and cartilage. A lightning injury may change the normal electric systems of the heart, brain, and spinal cord. It may cause spasms (tightening) of blood vessels and muscles. Your skin and other body areas, such as your eyes and ears, may be hurt. Know what to do before lightning strikes, and if you are in a storm. Giving or getting help right away can save a person's life or prevent long-lasting effects. While some people with lightning injuries recover quickly, other people have long-lasting medical conditions or other problems.

What else should I know about lightning?

• Lightning can occur even if the sky is clear or when it is sunny.
  
  
• Lightning can strike the same place more than once.
  
  
• Lightning can easily travel through metal for long distances.
  
  
• Lightning does not always hit an object.
  
  
• Wearing metal, such as jewelry, does not increase your risk of being hit by lightning.
  
  
• Winter lightning (thunder blizzard) tends to be more powerful than summer lightning.

How does lightning cause injuries? Lightning can cause injuries in the following ways:

• Direct strike: This occurs when the lightning strikes you directly. Lightning most often hits a person directly when they are in an open area or outdoors. This usually happens when a person cannot find shelter in a safe place.
  
  
• Splash injury: The lightning may have struck or jumped from one source to another on its way to the ground. This type of injury occurs when lightning has hit a tree, building, or object and splashes onto a victim. Splashes can occur from person to person, tree to a person, or even indoors from plumbing or telephone wires to people.
  
  
• Contact injury: This occurs when you touch or hold an object that has just been struck or splashed by lightning.
  
  
• Step voltage: The lightning current may spread through the ground from the site of the strike. This current can travel up one leg and down the other leg if you are standing near the strike area.
  
  
• Blunt trauma: A lightning strike can have a strong force that will throw you for up to 10 yards or more. This may damage your brain, your ears, and other body areas. You may also have bruising or swelling after this type of strike.

What are the signs and symptoms of lightning injuries? You may not see a lightning injury right away, but it may still be there. Injuries can be mild or severe (very bad). They can last for a short time, or be long-term. You may have one or more of the following:

• Burns that may be painful or painless. Your skin may also be swollen, a strange color, or hurt.
  
  
• Fever, body weakness, nausea (upset stomach), or vomiting (throwing up).
  
  
• Fractures (broken bones).
  
  
• Headache, loss of consciousness (passing out), confusion, or trouble staying awake.
  
  
• Irregular or fast breathing, a fast or irregular heartbeat, or low blood pressure. With low blood pressure, you may be dizzy.
  
  
• Muscle pain, weakness, tenderness, stiffness, or shortened joints and muscles.
  
  
• Weak or no pulse.

What other problems can lightning injuries cause? The following may appear a few days, months, or even years after being struck by lightning:

• Bleeding inside your body.
  
  
• Brain damage, such as trouble thinking clearly or staying awake, confusion, or being forgetful.
  
  
• Kidney failure, such as having dark-colored urine or less urine than usual.
  
  
• Paralysis (not able to move your arms or legs).
  
  
• Problems seeing or hearing.
  
  
• Seizures (convulsions), cardiac arrest (heart stops working), coma, or death. Coma is when you are in a deep, sleep-like state.

How are lightning injuries diagnosed? Your caregiver will ask you about past medical conditions, and check you over. You may need one or more of the following:

• 12-lead ECG: This test, also called an EKG, helps caregivers look for damage or problems in different areas of the heart. Caregivers may need to prepare your skin by shaving off some hair, or cleaning it with a gritty lotion. Sticky pads are placed on your chest, arms, and legs. Each sticky pad has a wire that is hooked to a machine or TV-type screen. A short period of electrical activity in your heart muscle is recorded. Caregivers will look closely for certain problems or changes in how your heart is working. This test takes about 5 to 10 minutes. It is important that you lie as still as possible during the test. You may need this test more than once.
  
  
• Blood gases: This test is also called an arterial blood gas or ABG test. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. The groin is the area where your abdomen meets your upper leg. Your blood is tested for the amount of "gases" in it, such as oxygen, acids, and carbon dioxide.
  
  
• Blood and urine tests: Samples of your blood and urine are collected and sent to a lab for tests.
  
  
• Imaging tests: You may need to have x-rays, or computed tomography (CT) or magnetic resonance imaging scan. These pictures may show bones that have moved or are broken. He may also check if the organs inside your body have been hurt.
  
  
• Neurologic signs: Neurologic signs are also called neuro signs, neuro checks, or neuro status. Caregivers check your eyes, your memory, and how easily you wake up. Your hand grasp and balance may also be tested. This helps tell caregivers how your brain is working after an injury or illness. You may need to have your neuro signs checked often. Your caregiver may even have to wake you up to check your neuro signs.

How are lightning injuries treated? Treatment depends on the kind of lightning injury you have. Even if you feel well after being struck by lightning, get checked by a caregiver. You may need one or more of the following:

• Blood transfusion: A blood transfusion may be needed if you have severe bleeding. Whole blood or parts of blood will be given through a small tube placed in your vein. The risk of getting AIDS, hepatitis, or West Nile Virus from a blood transfusion is rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile Virus. If you refuse a blood transfusion, your condition may get worse. Ask your caregiver for more information on receiving blood products.
  
  
• Counseling or rehabilitation: Your caregiver may talk to you, your family, friends, or those close to you. He may explain the problems that can occur after a lightning injury. Your caregiver may suggest that you go into a treatment program if you are depressed, or if you abuse alcohol or drugs. These programs may help you learn how to control or stop a drinking or drug problem.
  
  
• Dialysis: Dialysis cleans your blood when your kidneys cannot. Extra water, chemicals, and waste products are removed from your blood by a dialyzer or dialysis machine. The dialysis machine does this by passing your blood through a special filter, then returning it back to you. You may need dialysis for a short time, or for the rest of your life. Caregivers will check your vital signs often during dialysis. You may also be given medicines or have blood taken for lab tests during dialysis.
  
  
• Intravenous fluids: If you need extra fluids in your body, your caregiver may give you intravenous (IV) fluids. These are liquid solutions that contain water, mineral salts, sugars, and proteins. These may be given through your vein.
  
  
• Medicines:
  
  
  • Alkalinizing medicine: These medicines help decrease high amounts of acid in your blood and urine caused by muscle injury.
    
    
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Diuretics: These medicines, often called water pills, help decrease swelling in your brain and provide better blood flow. Diuretics also get rid of extra fluid in your legs and ankles, lungs, and around your heart. You may pass urine more often when taking these medicines.
    
    
  • Medicines for pain, swelling, or fever: You may be given medicines to treat pain, swelling, or fever while you are in the hospital. These medicines are safe for most people to use. However, they can cause serious problems when used by people with certain medical conditions. Tell caregivers if you have liver or kidney disease, a history of bleeding in your stomach, or any other medical problems. Also tell your caregiver about any allergies you have to medicines. Tell your caregiver about all other medicines, herbs, and supplements that you have taken lately.
    
    
  • Other medicines: You may need to take medicine to treat other medical problems. These problems may include low blood pressure, seizures, or problems with your heart, kidneys, or muscles.
  
  
• Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. An endotracheal tube may be put into your mouth or nose. It goes into your windpipe to help keep your airway open and help you breathe. It may be hooked to a ventilator (breathing machine), and you may get extra oxygen through your ET tube. You will not be able to talk while the ET tube is in place.
  
  
• Surgery, wound care, and other procedures: Surgery and other treatment may be needed if you have burns, wounds, or other injuries.
  
  
• Therapy: A physical therapist and an occupational therapist may exercise your arms, legs, and hands. They may also teach you new ways to do things around the house. A speech therapist may work with you to help you talk or swallow.

What should I do if I find someone with a lightning injury? A person with a lightning injury is safe to be touched. If you are not also at risk of getting a lightning injury, check if the person is breathing. If they are not, start rescue breathing and CPR (basic life support). Have someone call 911 right away. Ask caregivers for information about how to do lay person CPR.

How can lightning injuries be prevented? Learn more about lightning and how it works. Learn how to prevent lightning injuries. The following will help prevent lightning injuries:

• Before a thunderstorm:
  
  
  • Listen to the weather on a battery-run radio or television (TV). If thunderstorms are in your area, do not go outside.
    
    
  • Carry a small radio to get updates of weather reports if you need to be outside.
    
    
  • Be ready to seek a safe place if you learn that a very bad thunderstorm is coming.
    
    
  • Unplug electric appliances such as computers and toasters.
  
  
• During a thunderstorm: Seek shelter in a safe building that has a roof, walls, and floor. The safest places are houses, schools, office buildings, or a shopping mall. You may also stay inside an all-metal vehicle, car, truck, or van. Do not stay in a convertible or other topless or soft-top vehicle, or ride a bicycle.
  
  
  • If you are indoors: Stay inside for 30 minutes more after you hear the last sound of thunder. Avoid open doors or windows, fireplaces, bath tubs, showers, and metal objects. Lightning may travel down wires and pipes indoors.
    
    
  • If you are outdoors: When you hear thunder, run to the nearest safe building.
    
    
    • Avoid metal objects, such as motorcycles, bicycles, tractors, fences or objects that are taller than you. Drop golf clubs, ski poles, umbrellas, metal clotheslines, or anything that may increase your height.
      
      
    • If you are trapped out in the open, stay away from trees that stand alone. Do not stand near tall trees, in a clearing, or on a hilltop. Avoid staying near pipelines, power lines, ski lifts, and other structures made of steel.
      
      
    • If you are in a forest, stay near a lower stand of thick trees. Sit down in caves, ditches, or valleys without water.
      
      
    • If you are in a tent, stay far away from the metal support poles or any wet garments.
      
      
    • If you are in a sports field, run to a school bus or mini van and get inside.
      
      
    • If you are in a large group, spread out and stay several yards away from each other. Squat down with both feet together. Cover your ears with your hands to avoid ear injuries. If you cannot squat, kneel on the ground or sit cross-legged.
      
      
    • If you are boating or swimming (open water or in a swimming pool), get out of the water. Head to the shore and find a safe shelter. Avoid being the tallest object near a large, open body of water.

Where can I find support and more information? Lightning injuries may be life-changing for you and your family. Accepting that you had a lightning injury may be hard. You and those close to you may feel sad, angry, or scared. These are normal feelings. Talk to your caregivers, family, or friends about your feelings. Contact the following for more information:

• Centers for Disease Control and Prevention Mass Trauma
  1600 Clifton Rd.
  Atlanta, GA, 30333
  Web Address: www.cdc.gov/masstrauma
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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