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.
Review
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.
Sources
ROČŇÁK, Luboš. Činnost a kompetence Horské služby s návazností na zdravotnickou záchrannou službu [online]. 2012, 35 [cit. 2023-01-04]. Avaible from:: https://adoc.pub/innost-a-kompetence-horske-sluby-s-navaznosti-na-zdravotnick.html
ŠEVČÍK, Pavel. Intenzivní medicína. 3. Prague: Galén, 2014. ISBN 9788074920660. FRELICH, Michal. Dětské polytrauma. 1. Prague: Grada, 2022. ISBN 978-80-271-2561-6.
SHIPMAN J, CARVER B, PAINTER K, SHIPMAN S. The Dangerous Life of a Storm Chaser: A Lightning Strike Injury Causing Serious Injury. J Investig Med High Impact Case Rep. 2020 Jan-Dec;8:2324709620925566. doi: 10.1177/2324709620925566. PMID: 32462924; PMCID: PMC7262986.
UZEL Şener M, DEMIR A, ŞEMER A. Lightning-strike-induced acute lung injury: a case report. Ulus Travma Acil Cerrahi Derg. 2019 Mar;25(2):198-201. English. doi: 10.5505/tjtes.2018.41861. PMID: 30892668.
van WAES OJ, van de WOESTIJINE, HALM JA. "Thunderstruck": penetrating thoracic injury from lightning strike. Ann Emerg Med. 2014 Apr;63(4):457-9. doi: 10.1016/j.annemergmed.2013.08.021. Epub 2013 Sep 18. PMID: 24054789.
THOMSON EM, HOWARD TM. Lightning injuries in sports and recreation. Curr Sports Med Rep. 2013 Mar-Apr;12(2):120-4. doi: 10.1249/JSR.0b013e318287728f. PMID: 23478564.
BLUMENTHALl R. Lightning and the Forensic Pathologist. Acad Forensic Pathol. 2018 Mar;8(1):98-111. doi: 10.23907/2018.007. Epub 2018 Mar 7. PMID: 31240028; PMCID: PMC6474460.
JENSEN JD, THURMAN J, VINCENT AL. Lightning Injuries. [Updated 2022 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441920/
TOLUNAY Oflu A, KACAR E, PEKTAS A, BUKULMEZ A. A rare complication of lightning strike: Pulmonary contusion. North Clin Istanb. 2020 Dec 31;8(6):619-622. doi: 10.14744/nci.2020.24022. PMID: 35284794; PMCID: PMC8848497.
Learning targets
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
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.
