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Lightning Injuries

Practice Essentials

Lightning is the most common weather threat to life that people worldwide encounter, sometimes on a daily basis and often without knowledge of behaviors they can use to avoid injury.

Lightning is not “scalable”—one cannot use his or her experience and knowledge of 110-volt household current or high-voltage injuries to predict what lightning will do. The physics of lightning is incredibly complex and substantially different from the physics of human-generated electricity.

Lightning is a neurological injury in developed countries, and not a significant burn injury in most cases. In developing countries, it causes significant burns under special circumstances, as well as neurological and long-term injury.

In developed countries, lightning burns are generally superficial.
Lightning injuries are not like electrical injuries and very rarely cause myoglobinuria or deep muscle injury that might require an escharotomy, fluid loading, or other measures used for electrical injuries.

Lightning has a very different behavior, different physics, and different injury patterns than manufactured electricity.

Lightning injuries are largely preventable in developed countries, but not in developing countries, owing to the lack of safe areas (eg, substantial, inhabitable buildings or all metal vehicles) that people can evacuate to and lack of knowledge on what behaviors to take

Direct lightning strikes cause only 3-5% of injuries and deaths, so safety measures and injury prevention education must always take into account the other mechanisms of injury: ground current (~50-55% of deaths and injuries), side-flash, upward streamer, and contact.
Survivors may also show signs of blast injury, including shrapnel, since being close to a lightning strike is similar to being within the blast range of an explosion; the thermodynamics within 10 m of lightning is equivalent to approximately a 10-lb (4.5-kg) TNT explosive. A 10-lb TNT-equivalent bomb would rupture an eardrum within 10 m, lung damage would occur at about 5 m, and the body would be injured at about 3 m.

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