Lightning delivers a huge but very brief current that can stop the heart and breathing at once, yet it usually causes only superficial burns. Most victims survive, and those in cardiac arrest have a good chance if CPR and ventilation start quickly.
Key symptoms
- Collapse or loss of consciousness
- Confusion and memory loss
- Temporary limb paralysis (keraunoparalysis)
- Hearing loss, ringing ears or vision problems
- Burns or fern-like skin marks
What you find on exam
- Scene safety: move to shelter if the storm continues; victims carry no charge
- ABCs and pulse; breathing may stay absent after the pulse returns
- Lichtenberg figures and burns
- Eardrums and eyes
- Trauma survey for blast or fall injuries, including the spine
Tests
- ECG and cardiac monitoring
- Troponin and CK
- Urinalysis
- CT of the head if mental status is altered
Treatment basics
- Reverse triage with several victims: treat those who appear dead first
- CPR, AED and prolonged ventilation; breathing arrest can outlast cardiac arrest
- Spinal motion restriction if the patient fell or was thrown
- Treat burns and monitor for arrhythmia
- Eye and ear follow-up; cataracts can appear later
Red flags
- Cardiac or respiratory arrest
- Persistent altered consciousness
- Arrhythmia or chest pain
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic); AHA Guidelines for CPR and ECC. Written by Making Synapses. Making Synapses is not affiliated with these organizations.