Role of the Emergency Department in Lightning Strike Victims: An Overview

Introduction

Lightning strikes are an uncommon but deadly natural occurrence that can cause serious harm to anybody in their proximity. To provide the victims with prompt and thorough care, the emergency department is critical in managing victims of lightning strikes. When treating a variety of injuries caused by lightning strikes, both obvious and invisible, the emergency room is the first place to go. Thus, the emergency department (ED) plays a critical role in evaluating, diagnosing, and treating victims of lightning strikes.

What Are the Clinical Presentations of Lightning Strike Victims in the Emergency Department?

1. Cardiorespiratory - A lightning strike's two most serious side effects are respiratory arrest and cardiac arrhythmias.

• After lightning, asystole is the most prevalent arrhythmia. If bystander CPR (cardiopulmonary resuscitation) is started quickly, there is a 50 percent chance of survival.

• Respiratory arrest occurs due to temporary paralysis of the medullary respiratory center. In this case, ventilator assistance is crucial because survival depends greatly on how long the unsupported apnea lasts.

• Following a strike, fixed dilated pupils are temporary and inadequate for resuscitation advice.

• The ECG may indicate ST alterations, QT prolongation, AF, other symptoms, and other cardiovascular consequences like VF or asystole. Pericarditis is another clinical presentation seen in lightning strike victims.

2. Neurological

• Lightning strikes can potentially cause complicated neurological damage that impacts the peripheral, autonomic, and central nervous systems. Anterograde amnesia, disorientation, and unconsciousness are frequent symptoms suffered by victims. Seizures, brain bleeding, strokes, and damage to peripheral nerves are examples of severe outcomes.

• The unusual result of lightning strikes, known as keraunoparalysis, is transient paralysis of the limbs. Vasospasm, a disorder where blood vessels constrict excessively, causes affected limbs to appear chilly, pallid, and mottled. Keraunoparalysis usually goes away in six to 24 hours. But to guarantee appropriate medical care if symptoms continue after this period, more research into alternative limb dysfunction reasons is essential.

3. Burns - A person's skin only briefly comes into contact with the great majority of lightning energy flashes surrounding their body surface; in most cases, this contact is too fleeting to cause significant skin burns. When referring to lightning injuries, entry and departure are improper terminology. A direct blow does not injure most patients; most are affected by surrounding strikes that cause mechanical, thermal, or electrical damage. Fewer people get internal burns. When burns happen, they are typically superficial and come from contact with hot surfaces or fire from the impact. Here is an illustration of classical ferning in action. It is not a true burn; electron showers across the skin cause this and should disappear in a day or two.

4. Other Injuries - Cataracts are a common delayed result of eye injuries, such as retinal detachment or optic nerve injury. Fifty percent of tympanic membrane rupture cases result in tinnitus and sensorineural deafness, which are additional common effects on the ears.

What Is the Role of the Emergency Department in Caring for the Lightning Strike Victims?

• Initial Assessment - A preliminary assessment is performed when a patient struck by lightning is brought to the emergency room. For the medical team to quickly determine the extent of damage, this assessment is crucial for assessing the patient's vital signs and general health. To quickly handle any potentially fatal consequences that may arise from the lightning strike, the assessment is an essential first step in determining priorities and providing the necessary medical care.

• Cardiorespiratory Assessment - Cardiac and respiratory monitoring is imperative for lightning strike victims, as electrical shock can induce cardiac and respiratory arrest. Continuous monitoring is essential to promptly identify any irregular heart rhythms and initiate appropriate interventions, including defibrillation when necessary. Lightning-induced electrical injuries can disrupt the heart's electrical pathways, potentially leading to life-threatening arrhythmias. This vigilant monitoring enables healthcare providers to respond swiftly and effectively, ensuring the best possible outcomes for patients affected by lightning strikes.

• CPR and Resuscitation - Emergency room personnel may perform cardiopulmonary resuscitation (CPR) in cases of cardiac arrest or respiratory distress in order to maintain circulation and oxygenation. In order to ensure that crucial oxygen reaches the brain and other organs until advanced medical care can be given, CPR entails chest compressions and rescue breathing.

• Assessment and Management of Burns - Lightning strikes can result in entrance and exit burns. In addition to providing appropriate wound care and pain control, the emergency department will evaluate the degree and severity of these burns.

• Evaluation of the Neurological System - Various neurological effects, from minor confusion to serious traumatic brain damage, can result from lightning strikes. To diagnose and treat these illnesses, neurological examination and imaging may be necessary. These procedures aid medical experts in determining the level of damage and in creating treatment regimens that are suitable for neurological disorders resulting from lightning strikes.

• Ophthalmologic Evaluation - Since lightning strikes emit a lot of heat and light, they can cause injury to the eyes. To identify and treat a possible visual injury, ophthalmologic tests are carried out. These tests help identify and treat lightning-related eye conditions, guaranteeing prompt and effective care for any potential injuries or visual impairments.

• Respiratory Support - Lightning strikes have the potential to harm the lungs and other respiratory organs. If a patient's breathing is impaired, they might need to use mechanical ventilation or oxygen therapy.

• Fluid Resuscitation - Lightning strikes victims’ sweat a lot. Heavy sweating might cause electrolyte imbalances or dehydration in lightning-struck victims. Intravenous (IV) fluids may be given to keep the right fluid balance.

• Pain Management - Lightning strike victims suffer pain from burns, musculoskeletal injuries, or nerve damage; hence, pain management is essential for survivors of lightning strikes. Pain management strategies that are effective in reducing pain, enhancing comfort, and promoting healing are critical to allowing individuals to recover from the traumatic experience and resume normalcy. These strategies may include medication and therapy.

• Tetanus Prophylaxis - Tetanus prophylaxis may be necessary when treating lightning strike injuries because these injuries can raise the risk of infection.

• Observing Complications - Patients may need continuous monitoring for conditions including acute renal injury, respiratory distress, arrhythmias, and other medical conditions.

• Referral and Follow-up - Based on the extent of the injuries, lightning strike victims can need continuous medical attention, rehabilitation, or follow-up visits with experts in different disciplines, such as ophthalmology or neurology.

Conclusion

Early examination, stabilization, and immediate management of lightning-struck victims depend on the healthcare workers working in the emergency department. Since lightning strikes can have long-term physical and psychological impacts, it is essential to remember that the emergency department's responsibility extends beyond providing emergency care and ensuring that the patients receive the right support and care during their treatment and recovery period. Although lightning strikes are uncommon, they can be fatal; therefore, the emergency department must act quickly and thoroughly.