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Abstract
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Lightning injuries can be fatal, but the vast majority of people struck by lightning survive. Although data are incomplete, lightning causes about 24,000 deaths worldwide every year, with about 250,000 injuries.1
Long-term medical and psychiatric sequelae are common.
Lightning does not usually cause burns. Most burns from lightning are superficial, caused by vaporization of sweat on the skin and in clothing. Unusual types of burns caused by lightning include punctate and linear burns. Lightning can also produce transient feathering patterns on the skin (Lichtenberg figures) that are not burns. Feathering is pathognomonic for lightning injury but is not always seen.
A healthy 33-y-old man was hiking with 2 friends in the Spanish Pyrenees during the summer. In the early afternoon, he reached the high point of the hike (2400 m). Suddenly, he heard a boom and felt something hit his left shoulder. He was unconscious for a few seconds. When he awoke, he was rolling down a slope. He seemed to be paralyzed. He stopped at a flat spot about 15 m below the high point. A few seconds later, he smelled burnt clothing. He was then able to make limited movements and called for help. His left arm was blue for a few minutes. His friends found him and notified emergency services. A rescue helicopter extricated him, with some difficulty because of the weather, and transferred him to an air ambulance. Vital signs were respiratory rate 16·min-1, heart rate 86 beats·min-1, blood pressure 164/76 mm Hg, and oxygen saturation by pulse oximeter (SpO2) 99%. He still had weakness of the legs during extrication that resolved before he reached the hospital.
When the patient arrived at the hospital, he said that something had exploded at his side, knocking him down the mountain. He reported back pain and bruises from the rocks over which he had rolled. On examination he was alert, in no respiratory distress, and able to converse normally. His Glasgow Coma Score was 15...
Language: en |