Lightning strike

A lightning strike is a type of electrical injury of a short duration, when a current above 80 mA already causes a permanent cardiac arrest. In addition to current magnitude, voltage and duration, the consequences of a lightning strike also depend on the resistance and direction of the current. The consequences of a direct lightning strike are often fatal (30 – 40%), when the patient dies for cardiac arrest due to malignant arrhythmia and respiratory arrest due to weakening of the respiratory center. Most often a person is hit indirectly, through the ground or objects. However, we must not forget about secondary organ damage either.

lightning strike
electric current
Published at: 31.7.2023


Bohumil Bakalář, MD
Chief Physician of ICU for Adults, Department of Burn Medicine, Královské Vinohrady University Hospital, Prague, Czech Republic

The "Lightning strike" algorithm describes a situation that sometimes occurs (for example in 2017 a woman was struck by lightning between houses in the Střížkov housing estate in Prague, and subsequently died at our workplace). As this is a less frequent but life-threatening injury, prior preparation for dealing with such a situation is very important. The scenario of the algorithm is conceived from the onset of the critical situation, initial treatment, pre-hospital assistance, examination at the trauma centre, hospitalisation in the intensive care bed and discharge. It therefore covers the whole spectrum of management of the injured person. The information conveyed is logical and medically correct. Each step is accompanied by a photographic illustration, and an explanatory and expanding commentary appears when the correct answer is selected. It is thus an appealing and interactive format, with a strong immersive quality, which has a strong potential for memorization of the subject matter. The final physics summary and probability questions from other areas are interesting and entertaining. Overall, in my opinion, this is a very well prepared, thought out and managed "learning through play" - this is probably what a modern tutorial should look like.


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Learning targets

1. The student is able to diagnose electric shock
2. The student can provide pre-hospital care and subsequently hospital care in the event of a lightning strike.
3. The student knows how to distinguish lightning strikes from other physical causes of injuries and is able to recognize direct and indirect strikes.

Key points

1. For successful first aid and lightning strike therapy, it is important to know the type of electrical current used by lightning.
2. From the point of view of accurate diagnosis and comprehensive care, it is important to know the effects of electric current on individual tissues of the human body.
3. As part of an accurate diagnosis, it is necessary to think about the possibility of secondary injury caused by a shock wave or a fall.