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Lightning injury

Key sources
The following summarized guidelines for the evaluation and management of lightning injury are prepared by our editorial team based on guidelines from the Wilderness Medical Society (WMS 2014).


1.Diagnostic investigations

Cardiac evaluation: obtain a screening ECG and echocardiography in high-risk patients once evacuated, including patients experiencing a direct strike or patients complaining of chest pain or dyspnea.
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  • Neurologic evaluation

  • Dermatologic evaluation

  • Ophthalmologic evaluation

  • Otolaryngologic evaluation

2.Medical management

Resuscitation: initiate resuscitation in victims of lightning strike immediately if the scene otherwise is deemed safe. Recognize that these victims do not carry residual electrical charge. Use the basic and advanced life support algorithms, including trauma when appropriate, as the standard of care. Follow current advanced life support guidelines for lightning victims requiring resuscitation.

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  • Triage and evacuation

3.Specific circumstances

Pregnant patients: evacuate pregnant patients > 20 weeks of gestation struck by lightning to a hospital for lightning-associated injury screening and fetal monitoring. Do not obtain fetal monitoring for pregnancies < 20 weeks of gestation as they are not considered viable.

4.Preventative measures

Thunderstorm safety: advise waiting a minimum of 30 minutes after hearing the last thunderclap before resuming outdoor activity to allow for the trailing edge of the thunderstorm to move the estimated 16 km (10 miles) needed to establish an appropriate buffer zone.
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