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Lightning Injuries, Emergency Medicine

Reviewed 06/2017



  • Lightning is a discharge of energy that occurs cloud to cloud (90%) or cloud to ground (10%).

  • Exposure to lightning:

    • Brief duration (1–100 msec)

    • Typically occurs during outdoor activity

    • ...


Signs and Symptoms


  • Consider lightning strike in unwitnessed falls, cardiac arrests, or unexplained coma in an outdoor setting.

  • Conscious patients may report:

    • Muscle aches and pains

    • Chest ...



  • Field triage should rapidly focus on providing ventilatory support to unconscious victims or those in cardiopulmonary arrest:

    • Prevents primary cardiac arrest from degenerating int...



Admission Criteria

  • Postcardiac arrest patients

  • History of change in mental status/altered level of consciousness

  • History of chest pain, dysrhythmias, or ECG changes:

    • May not resolve s...

Pearls and Pitfalls

  • Do not follow burn treatment formulas for lightning burns and injuries.

  • Be diligent in the primary and secondary survey so as not to miss occult injuries.

  • Have a low threshold to adm...

Additional Reading

  • Cooper  MA, Andrews  CJ, Holle  RL. Lightning injuries. In: Auerbach  PS, ed. Wilderness Medicine. 5th ed. St. Louis, MO: Mosby; 2007:67–108.

  • Cooper  MA, Holle  RL. Mechanisms of l...



  • 949.0 Burn of unspecified site, unspecified degree

  • 994.0 Effects of lightning

  • 994.8 Electrocution and nonfatal effects of electric current


  • T30.0 Burn of unspecified body region, unspecifie...

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