Lightning Strike InjuryMANAGEMENT

ENVIRONMENTAL AND EXPOSURE PRESENTATIONS · 12 SECTIONS

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724 items

☷ Legend

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Cardiovascular Presentations71▾

Respiratory Presentations52▾

Neurological Presentations83▾

Gastrointestinal Presentations74▾

Genitourinary and Reproductive Presentations48▾

Infectious Disease Presentations148▾

Trauma Presentations89▾

Toxicologic Presentations80▾

Psychiatric Presentations26▾

Musculoskeletal and Rheumatologic Presentations96▾

Dermatology Presentations23▾

Environmental and Exposure Presentations27▾

Acute Mountain Sickness Arterial Gas Embolism Bee-Wasp Sting (Anaphylaxis)Chilblains Ciguatera Fish Poisoning Coral Cut Decompression Sickness Electrical Burn Injury Envenomation (snake, spider, insect)High Altitude Cerebral Edema (HACE)High Altitude Pulmonary Edema (HAPE)High-altitude illness Hypothermia Hypothermia (Mild)Hypothermia (Severe)Immersion Foot Lightning Strike Injury Scombroid Fish Poisoning Scorpion Envenomation Sea Urchin Injury Shark Bite Snake Envenomation Spider Bite (Black Widow)Spider Bite (Brown Recluse)Stingray Spine Injury Tick paralysis White Phosphorus Burn

Hematologic and Oncologic Presentations36▾

Pediatric-Specific Presentations19▾

Endocrine and Metabolic Presentations45▾

ENT and Maxillofacial Presentations27▾

Ophthalmologic Presentations19▾

Obstetric Presentations23▾

Systemic and Miscellaneous Presentations17▾

01Approach to the Critical Patient/attcp65

Immediate Priorities

›Airway and breathing

›Respiratory arrest persists after ROSC due to medullary paralysis

›Ventilatory support is the highest priority

›Failure to ventilate causes secondary cardiac arrest

›Airway compromise

›Burns or edema to oropharynx

›Reduced GCS with inability to protect airway

›If airway compromise, proceed to rapid sequence intubation

›Class I recommendation

›Pre-oxygenate aggressively before attempt

›Circulation

›Cardiac arrest management

›Asystole or VF are the leading immediate causes of death

›Aggressive and prolonged ACLS resuscitation is warranted

›Survival with intact neurologic function documented after prolonged arrest

›Reverse triage for mass casualty

›Prioritize those who appear dead — highest chance of survival with resuscitation

›Walking wounded have greatest physiologic reserve

›Hemodynamic targets post-ROSC

›MAP >65 mmHg

›SBP >90 mmHg

›C-spine immobilization

›Assume spinal injury until cleared

›Blast effect and muscular tetanic contraction cause spinal fractures

›Clinically clear only after full neurologic assessment when possible

Key Concepts

›Lightning vs high-voltage electrical injury distinction

02History/hx93

Mechanism of Injury

›Lightning strike mechanism type

›Direct strike

›Highest energy transfer

›Most fatalities

›Side flash (splash)

›Current jumps from struck nearby object

›Second most dangerous mechanism

›Ground current (step potential)

›Most common mechanism overall

›Current travels along ground surface and enters through feet

›Contact injury

›Touching object that was struck

›Upward streamer

›Person is source of upward channel that does not complete to cloud

›Blunt effects without full current transfer

Presenting Symptoms

›Neurologic symptoms

›Loss of consciousness

›Duration and whether witnessed

›Retrograde and anterograde amnesia extremely common

›Confusion

›Persistent altered mental status is alarm feature

›Headache

›Paresthesias

›Extremity numbness and weakness

›Seizure

›Cardiovascular symptoms

›Chest pain

›Palpitations

›Syncope

›Otologic symptoms

›Hearing loss

›Tympanic membrane perforation

›Tinnitus

›Vertigo

›Ophthalmologic symptoms

›Vision changes

›Photophobia

›Eye pain

›Note: cataracts may develop 2 days to 4 years post-injury

›Musculoskeletal symptoms

›Myalgias

›Back and spine pain from blast effect

›Dark urine suggesting myoglobinuria

›Psychiatric symptoms

›Anxiety

›Sleep disturbance

›Emotional lability

Setting and Context

›Scene details

›Outdoor activity during thunderstorm

›Hiking, sports, farming, fishing, golf

›Construction work

›Proximity to struck object

›Under tree, near tall isolated structure

›Water exposure increases ground current spread

›Metal objects worn

›Belt buckles, jewelry, zippers

›Contact burns from heated metal

›Telephone or landline use during storm

›Rare but documented injury mechanism

›Temporal context

›Peak season: May to September

›Peak hours: 10 AM to 7 PM

›Symptom timing: immediate vs. delayed onset

›Delayed cardiac and neurologic effects reported up to 3 days

Risk Factors

›Demographic risk

›Male sex

›Approximately 2:1 male predominance

›Young, active individuals

›Most victims are outdoor recreationalists

›Occupational exposure

›Agriculture, construction, military outdoor training

›Geographic and temporal risk

›Open fields and elevated terrain

›Near tall isolated objects such as trees

›High-lightning-density regions

Past Medical History

›Cardiac history

›Pre-existing arrhythmia or structural heart disease

›Underlying long QT or Brugada syndrome may complicate ECG interpretation

›Implanted cardiac device

›Pacemaker or ICD may be damaged by the strike

›Neurologic history

›Seizure disorder — may confound post-strike neurologic assessment

›Prior lightning or electrical injury

›Psychiatric history

›Baseline for comparison given high rates of neuropsychiatric sequelae

Collateral History

›Witness account

›Mechanism observed (direct vs. splash vs. ground current)

›Duration of unresponsiveness

›Bystander CPR performed and duration

›Multiple casualties

›Lightning can injure multiple people simultaneously

›Apply reverse triage

›Those appearing dead have the best resuscitation potential

03Physical Exam/exam69

Vital Signs

›Hemodynamic assessment

›Blood pressure

›Labile blood pressures and autonomic instability are common

›Hypertension from catecholamine surge or hypotension from cardiac dysfunction

›Heart rate

›Tachycardia or bradycardia from autonomic dysregulation

›Temperature

›Hypothermia possible from outdoor exposure

›Respiratory rate

›Apnea or respiratory distress from medullary involvement

Skin

›Pathognomonic cutaneous findings

›Lichtenberg figures

›Fern-like branching erythematous pattern

›Appears within 1 hour, resolves in less than 24 hours

›Not a true burn — electron showers in superficial skin

›Pathognomonic for lightning strike

›Linear burns

›Partial thickness along sweat lines

›Axillae and inframammary folds

›Punctate burns

›Clustered small full-thickness burns, especially at toes (tip-toe sign)

›Ground current entry points

›Contact burns

›From heated metal objects: belt buckles, jewelry, zippers

›Singed hair

›Body and facial hair singed

04Differential Diagnosis/ddx41

Life-Threatening Mimics

›Primary cardiac arrest

›Acute myocardial infarction

›ST changes may be present post-lightning but coronary arteries are usually normal

›ICD-10: I21.9

›Primary ventricular fibrillation

›Distinguish by history of witnessed lightning event

›ICD-10: I49.01

›Intracranial hemorrhage

›Focal deficits, headache, altered mental status

›Cannot distinguish clinically from post-strike injury without CT

›ICD-10: I62.9

›Stroke

›Ischemic or hemorrhagic

›If no clear history of strike, full stroke workup warranted

›ICD-10: I63.9

Environmental Injury Mimics

›High-voltage electrical injury

›Prolonged contact with AC or DC current

›Deeper tissue destruction than lightning

›Higher amputation rate

›ICD-10: T75.4XXA

›Distinguishing features: entry and exit wounds, longer current exposure

›Heat stroke

›Outdoor setting, altered mental status, hyperthermia

›Absent: burns, Lichtenberg figures, cardiac arrest pattern

›ICD-10: T67.01XA

›Blast injury from explosion

05Laboratory Tests/lt38

Cardiac Markers

›Troponin (serial)

›Elevation indicates myocardial injury

›Obtain at presentation and repeat at 3–6 hours

›Limited predictive value for arrhythmia risk stratification

›Elevated troponin is indication for cardiology input

›CK and CK-MB

›Markedly elevated CK indicates rhabdomyolysis

›CK-MB fraction distinguishes myocardial from skeletal muscle source

›CK >5000 U/L associated with increased AKI risk

Rhabdomyolysis and Renal Assessment

›Urinalysis

›Myoglobinuria

›Dark or tea-colored urine

›Dipstick positive for blood without red cells on microscopy

›Hallmark of significant muscle injury

›Renal function panel

›Creatinine and BUN

›Acute kidney injury from myoglobin-induced tubular injury

›Establish baseline at presentation

›Serial monitoring every 6–12 hours if CK elevated

Metabolic and Hematologic

›Basic metabolic panel

›Electrolytes

›Hypokalemia and hypocalcemia are common post-strike

›Correct prior to treatment of arrhythmias

›Glucose

›Hypoglycemia may confound neurologic assessment

06Diagnostic Tests/dt98

Scoring Systems

›Scoring and risk stratification tools

›No validated lightning-specific risk score exists

›Risk stratification is clinical and ECG-based

›High-risk features warrant admission regardless of scoring tools

›High-risk features requiring admission

›Cardiac arrest or arrhythmia

›Loss of consciousness

›Abnormal ECG

›Elevated troponin or CK

›Neurologic deficits

›Significant burns

›Direct strike mechanism

›Low-risk features supporting discharge after observation

›Asymptomatic at presentation

›Normal 12-lead ECG

›Normal neurologic exam

›No LOC

›Ground current or contact mechanism only

ECG

›12-lead ECG — mandatory for all lightning strike patients

›Common post-strike ECG findings

›Sinus tachycardia

›Non-specific ST-T wave changes

›Prolonged QTc

›Bundle branch block

›Atrial fibrillation

›Ventricular tachycardia

›Transient nature of findings

›Most ECG changes resolve within 24–72 hours

›Coronary angiography warranted only if ST elevation with hemodynamic instability and no other explanation

›Continuous telemetry monitoring

›Minimum 24 hours for any symptomatic patient or abnormal ECG

›Delayed arrhythmias documented up to 3 days

Scoring Systems (continued 1)

›ICD-10 coding for lightning strike injury

›T75.00XA: Unspecified effects of lightning, initial encounter

›T75.01XA: Shock due to lightning, initial encounter

›T75.09XA: Other effects of lightning, initial encounter

›Secondary codes for complications

›Cardiac arrhythmia: I49.9

›Rhabdomyolysis: M62.82

›Burns: T20–T32 series by location and degree

MRI

›MRI brain

›Indications

›Persistent neurologic deficits not explained by CT findings

›Subacute or delayed neurologic deterioration

›Suspicion for spinal cord injury

›Expected findings

›White matter signal changes in delayed neurologic sequelae

›Basal ganglia and brainstem injury (diffusion-weighted imaging)

›Cord signal abnormalities in myelopathy cases

›Limitations

›Not routine in acute phase; CT is first-line for immediate decisions

›MRI findings may be delayed days to weeks after injury

›MRI spine

›If clinical concern for spinal cord involvement

›Numbness or weakness disproportionate to trauma

›Bladder or bowel dysfunction

›CT head without contrast

›Indications

›Any loss of consciousness

›Persistent altered mental status or GCS <15

›Focal neurologic deficits

›Suspected intracranial hemorrhage

›Expected findings

›Intracranial hemorrhage — basal ganglia and brainstem predilection

›Cerebral edema in severe cases

›Often normal in isolated lightning injury without structural trauma

›CT C-spine

›Indications

›Inability to clinically clear the cervical spine

›High-energy mechanism or direct strike to head

›Altered mental status precluding clinical assessment

›Protocol

›CT preferred over plain films for high-risk patients

›CT chest

›Indications

›Suspected pulmonary contusion from blast effect

›Pneumothorax or rib fractures

›Hemothorax

›Finding patterns

›Ground glass or consolidative opacities from contusion

›Pneumothorax from barotrauma

Ultrasound

›Point-of-care echocardiography

›Indications

›Hemodynamic instability

›Elevated troponin

›Significant ECG abnormalities

›Findings

›Wall motion abnormalities from myocardial stunning

›Reduced ejection fraction

›Takotsubo (stress) cardiomyopathy pattern

›Pericardial effusion

›Takotsubo cardiomyopathy

›Reversible within 72 hours in most cases

›Mimics anterior STEMI clinically

›FAST exam

›If associated trauma or hemodynamic instability

›Free fluid in abdomen or pelvis

›Pericardial effusion on subxiphoid view

07Disposition/dispo41

ICU Admission

›ICU criteria

›Post-cardiac arrest requiring monitoring and ventilatory support

›Targeted temperature management if indicated per ACLS protocol

›Cardiogenic shock or hemodynamic instability

›Vasopressor requirement

›Respiratory failure requiring intubation

›Intracranial hemorrhage requiring neurosurgical input

›Severe rhabdomyolysis with acute kidney injury

›CK markedly elevated and creatinine rising

Inpatient Admission

›General ward admission criteria

›Any cardiac arrhythmia

›Loss of consciousness or altered mental status (resolved)

›Abnormal ECG requiring telemetry

›Significant burns (full-thickness or >10% TBSA)

›Elevated troponin or significant CK elevation

›Neurologic deficits (even if improving)

›Direct strike mechanism regardless of initial clinical appearance

Discharge Criteria

›Criteria for discharge after observation period

›Asymptomatic at presentation

›No chest pain, palpitations, or dyspnea

›Normal 12-lead ECG

›Normal neurologic examination

›No loss of consciousness

›Low-risk mechanism (ground current or contact)

›Observation period 4–6 hours minimum

08Treatment/t83

Resuscitation

›Airway management

›Supplemental oxygen for all patients

›High-flow oxygen via non-rebreather if SpO2 <95%

›Bag-mask ventilation if respiratory arrest

›Ventilatory support is the priority — respiratory arrest outlasts cardiac arrest

›Secondary cardiac arrest occurs if ventilation is not supported

›Rapid sequence intubation for airway compromise

›Ketamine 1.5 mg/kg IV for induction

›Preserves hemodynamics in unstable patients

›Succinylcholine 1.5 mg/kg IV for paralysis

›Rocuronium 1.2 mg/kg IV if succinylcholine contraindicated

›Cardiac arrest management

›Standard ACLS protocol

›CPR 100–120 compressions per minute, full recoil

›Shock VF/pulseless VT with 200 J biphasic

›Epinephrine 1 mg IV every 3–5 minutes

›Standard ACLS dosing

›Amiodarone for refractory VF or pulseless VT

›300 mg IV bolus for first dose

›150 mg IV for second dose if needed

›Prolonged resuscitation is appropriate

›Young patients without underlying cardiac disease

›Survival with neurologic recovery documented after prolonged arrest

Arrhythmia Management

›Atrial fibrillation

›Rate control if hemodynamically stable

›Metoprolol 5 mg IV every 5 minutes up to 15 mg

›Target heart rate 60–100 beats/min

›Amiodarone for AF with rapid ventricular response or associated VT

›150 mg IV over 10 minutes

›1 mg/min infusion for 6 hours

›0.5 mg/min infusion for 18 hours

›Maximum 2.2 g in 24 hours

›Caution: avoid QT-prolonging drugs

›Lightning strike itself causes QT prolongation

›Ventricular tachycardia (stable, sustained)

›Amiodarone 150 mg IV over 10 minutes

›Repeat 150 mg if no response

›Synchronized cardioversion 100 J biphasic if hemodynamically unstable

Fluid Resuscitation

›IV fluid therapy

›Crystalloid resuscitation for rhabdomyolysis

›Normal saline or lactated Ringer's

›Initiate at 1–1.5 L/hr and titrate to urine output

›Target urine output 1–2 mL/kg/hr

›Monitor for volume overload

›Clinical reassessment every 1–2 hours

›Consider urinary alkalinization if myoglobinuria persists

›Sodium bicarbonate 1 mEq/kg IV to alkalinize urine

›Target urine pH >6.5

Burns Management

›Wound care

›Superficial burns: standard wound care with non-adherent dressing

›Most heal without surgical intervention

›Lichtenberg figures: no wound care required, they are not true burns

›Full-thickness burns: burn surgery consultation

›Approximately 10% of lightning burns require skin grafting

›Escharotomy if circumferential burns compromise perfusion

›Tetanus prophylaxis

›Standard burn and wound protocol

›Tetanus immunoglobulin if no prior immunization or unknown status

›Tetanus toxoid booster if last immunization >5 years ago

Neurologic Management

›Seizure management

›Lorazepam 0.1 mg/kg IV (maximum 4 mg) for active seizure

›Repeat once if no response at 5 minutes

›Levetiracetam 60 mg/kg IV (maximum 4500 mg) if benzodiazepines fail

›CT head urgent if first seizure or focal features

›Elevated ICP management

›If intracranial hemorrhage with mass effect

›Head of bed at 30 degrees

›Avoid hypotension and hypoxia

›Neurosurgical consultation for operative candidates

Electrolyte Correction

›Potassium

›Hypokalemia is common post-strike

›Correct prior to arrhythmia management

›Target K+ >3.5 mmol/L

›Potassium chloride 10–40 mmol IV in 100 mL saline over 1 hour

›Calcium

›Hypocalcemia correction

›Calcium gluconate 1–2 g IV over 10 minutes for symptomatic hypocalcemia

›Target corrected calcium >2.1 mmol/L

Analgesia

›Pain management

›Acetaminophen 1 g IV or PO every 6 hours for mild to moderate pain

›Morphine 0.05–0.1 mg/kg IV every 4 hours for moderate to severe pain

›Titrate to effect

›Avoid NSAIDs if rhabdomyolysis or renal impairment present

09Special Populations/sp51

Pregnancy

›Maternal lightning strike

›Fetal mortality reported despite maternal survival

›Fetal monitoring required even in asymptomatic mothers

›Fetal cardiac arrest can occur independently of maternal status

›Maternal resuscitation priority

›Standard ACLS resuscitation as in non-pregnant

›Left lateral tilt for uterine displacement after 20 weeks gestation

›Fetal assessment

›Continuous electronic fetal monitoring minimum 4–6 hours

›Obstetric consultation mandatory for all lightning strikes in pregnancy

›Uterine activity

›Preterm labour or placental abruption can be triggered by strike

›Low threshold for urgent delivery if fetal distress

›Radiation considerations

›CT imaging should not be withheld if clinically indicated

›Fetal radiation dose from CT head and chest is minimal

Geriatric

›Age-related considerations

›Higher baseline cardiac risk

›Pre-existing coronary artery disease, structural heart disease

›Lower threshold for echocardiography and cardiology input

›Increased susceptibility to arrhythmia

›Pre-existing conduction disease may worsen post-strike

›Prolonged QTc at baseline increases risk

›Dehydration and electrolyte disturbance

›Less physiologic reserve for fluid shifts

›Careful fluid resuscitation monitoring for volume overload

10Background/b83

Epidemiology

›Incidence and mortality

›Approximately 100 deaths and 400 injuries annually in the United States

›Global incidence estimated at 2000 deaths and 6000 injuries per year

›Mortality rate up to 30% for those struck

›Significant morbidity in up to 70% of survivors

›Primary cause of death is simultaneous cardiac and respiratory arrest

›Demographics

›Predominantly young, active individuals

›Male:female ratio approximately 2:1

›Outdoor recreationalists and occupational outdoor workers

›Seasonal and temporal peaks

›May to September predominance in Northern Hemisphere

›Peak hours 10 AM to 7 PM

›Geographic distribution

›Florida, Texas, Colorado highest incidence in the US

›Tropical and subtropical regions globally have highest burden

Pathophysiology

›Energy characteristics of lightning

›Duration: 1–100 milliseconds per strike

›DC current (unidirectional)

›Peak current 10,000–200,000 amperes

›Voltage 100 million to 1 billion volts

›Flashover effect

›Current travels over the surface of the body rather than through it

›Explains lower incidence of deep tissue destruction compared to high-voltage AC injury

›Explains rapid heating of trapped moisture causing clothing to explode off

›Cardiac effects

›Simultaneous cardiac and respiratory arrest

›Massive DC shock depolarizes myocardium — cardiac automaticity usually recovers

›Medullary paralysis persists after cardiac recovery

›Respiratory arrest outlasts cardiac arrest causing secondary cardiac arrest

›Myocardial injury

›Stunned myocardium and Takotsubo cardiomyopathy

›Resolves within 72 hours in most cases

›Arrhythmias

›Direct injury to conduction system

›Autonomic dysregulation from neurologic injury

›Neurologic effects

›Direct neuronal injury from current passage

›Basal ganglia, brainstem predilection for hemorrhage

›Progressive myelopathy from ascending vascular injury

›Keraunoparalysis

›Transient paralysis from autonomic vasospasm

›Resolves within hours

›Cutaneous effects

›Lichtenberg figures: superficial electron shower, not a true burn

›Flash burns from ignited clothing

›Contact burns from metal objects

›Barotrauma

›Thunder and shockwave cause tympanic membrane perforation

›Pulmonary contusion from blast

›Vertebral fractures from muscular tetanic contraction

Therapeutic Considerations

›Resuscitation philosophy

›Aggressive prolonged resuscitation is the standard of care

›Young, otherwise healthy victims

›Fixed dilated pupils are NOT a contraindication to resuscitation

›Survival with intact neurologic function after prolonged arrest is well-documented

›Prioritize ventilation over circulation

›Respiratory arrest outlasts cardiac arrest

›Secondary cardiac arrest from hypoxia is preventable

›Cardiac management principles

›Most arrhythmias are transient and self-limiting

›Continuous monitoring for minimum 24 hours

›Delayed arrhythmias documented up to 3 days

›Cardiac dysfunction (even severe) typically reversible within 72 hours

›Expectant supportive management before permanent device implantation

›Avoid premature ICD implantation in acute phase

›QT prolongation management

›Lightning strike causes QT prolongation

›Avoid all QT-prolonging medications in the acute phase

›Monitor QTc on serial ECGs

›Electrolyte correction reduces QT prolongation

›Correct potassium to >3.5 mmol/L

›Correct magnesium to >0.85 mmol/L

›Rhabdomyolysis management principles

›Aggressive IV crystalloid is cornerstone of treatment

›Prevent myoglobin-induced acute tubular necrosis

›Target urine output 1–2 mL/kg/hr

›Monitor for AKI with serial creatinine

›Evidence base

›No randomized controlled trials exist for lightning injury management

›Management is based on case series, expert consensus, and wilderness medicine guidelines

›Wilderness Medical Society 2014 guidelines are the primary evidence-based reference

›European Heart Journal 2018 review (Waldmann et al.) guides cardiac management

11Patient Discharge Instructions/pdi36

copy discharge instructions

›You were treated for a lightning strike injury

›Return to the Emergency Department immediately if you develop any of the following

›Chest pain, palpitations, or racing heart

›Feeling faint or losing consciousness

›Shortness of breath

›New weakness or numbness in any extremity

›Vision changes including blurring or loss of vision

›Seizure or convulsions

›Severe worsening headache

›Dark or tea-colored urine

›Confusion or worsening mental status

›Follow-up appointments scheduled

›See your family doctor within 1–2 weeks

›Neuropsychiatric symptoms including anxiety, sleep problems, and memory difficulty are common and may develop over days to weeks

›Report any new or worsening symptoms

›Ophthalmology appointment within 1–2 weeks if recommended

›Eye complications including cataracts can develop from 2 days to 4 years after the strike

›Report any changes in vision immediately

›Cardiology and neurology follow-up as arranged

›Expected recovery information

›Skin markings (Lichtenberg figures) will fade and disappear within 24 hours

›They are not true burns and require no wound care

›Minor burns should be kept clean and dry with the dressings provided

›Return if any sign of infection: redness spreading, pus, fever

›Mood changes, anxiety, sleep problems, and memory difficulty are very common after lightning strike

›PTSD, depression, and cognitive difficulties can persist for months

›Support group available: Lightning Strike and Electric Shock Survivors International (www.lightning-strike.org)

12References/r26

Guidelines and Key Sources

›van Ruler R, Eikendal T, Kooij FO, Tan ECTH. A Shocking Injury: A Clinical Review of Lightning Injuries Highlighting Pitfalls and a Treatment Protocol. Injury. 2022. PMID 36038387

›Primary comprehensive clinical review used for this protocol

›Covers pathophysiology, alarm features, diagnosis, and treatment

›Davis C, Engeln A, Johnson EL, et al. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Lightning Injuries: 2014 Update. Wilderness and Environmental Medicine. 2014.

›Primary evidence-based guideline for field and emergency management

›Covers prevention, triage, and acute treatment

›Waldmann V, Narayanan K, Combes N, et al. Electrical Cardiac Injuries: Current Concepts and Management. European Heart Journal. 2018. PMID 28444167

›Cardiac management framework for lightning and electrical injuries

›Covers arrhythmia monitoring, cardiac biomarkers, and device management

Landmark Studies

›Lichtenberg R, Dries D, Ward K, Marshall W, Scanlon P. Cardiovascular Effects of Lightning Strikes. Journal of the American College of Cardiology. 1993. PMID 8426021

›Established cardiac monitoring standards post-lightning

›Documented transient and permanent cardiac effects

›Dundon BK, Puri R, Leong DP, Worthley MI. Takotsubo Cardiomyopathy Following Lightning Strike. Emergency Medicine Journal. 2008. PMID 18573973

›Documented reversible cardiomyopathy from lightning

›Supports expectant management over early device implantation

›Kotagal S, Rawlings CA, Chen SC, Burris G, Npuriouri S. Neurologic, Psychiatric, and Cardiovascular Complications in Children Struck by Lightning. Pediatrics. 1982. PMID 6927248

›Established pediatric lightning injury spectrum

›Seyfrydova M, Rokyta R, Rajdl D, Huml M. Arrhythmias and Laboratory Abnormalities After an Electrical Accident: A Single-Center Retrospective Study of 333 Cases. Clinical Research in Cardiology. 2023. PMID 37526697

›Elevated lactate identified as independent risk factor for arrhythmia

›Informs laboratory risk stratification

›Fontanarosa PB. Electrical Shock and Lightning Strike. Annals of Emergency Medicine. 1993. PMID 8434837

›Early comprehensive emergency medicine review

›Established core clinical assessment framework

›Radulovic N, Mason SA, Rehou S, Godleski M, Jeschke MG. Acute and Long-Term Clinical, Neuropsychological and Return-to-Work Sequelae Following Electrical Injury: A Retrospective Cohort Study. BMJ Open. 2019. PMID 31092649

›Long-term neuropsychiatric outcome data

›Informs follow-up planning and patient counseling

Learn More: Lightning Strike Injury→

Comprehensive Clinical Review

Structured, evidence-informed, long-form analysis for deeper understanding.

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed August 18, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.