There are four patterns of lightning burns. Feathering is highly characteristic of lightning. It is a nonblanching, reddish-brown fern pattern which disappears in several days. If seen in an unaccompanied, comatose patient, lightning injury may be presumed. Vascular Intense vasomotor instability, possibly due to autonomic dysfunction, has been repeatedly documented in these patients.
Arterial spasm leads to cold, mottled, pulseless extremities.
This is usually a temporary finding, resolving spontaneously within hours. Ophthalmic More than half of all lightning victims suffer some form of ophthalmic injury, most commonly involving the cornea. Damage is the result of a combination of electrical energy and intense brightness. They can occur months or even years after the initial insult. Therapy is delayed since a percentage resolve spontaneously over time.