Visceral perforation following lightning strike is extremely rare. Lightning usually causes death by injuring the medullary centers of the brain, leading to cardiac asystole or respiratory arrest. Prompt life support measures contribute to successful resuscitation in many patients. Patients struck by lightning frequently have cardiac asystole which responds to a manual blow to the chest or spontaneously resolves after several minutes of cardiac massage and mouth to mouth resuscitation. Attention should be paid to possible fractures and spinal cord injuries incurred at the time of the accident.
Hospital management includes aggressive treatment of hypovolemic shock.
This is common after a lightning strike due to rapid loss of fluid into areas of tissue damage and from surface burns. This child responded rapidly to measures to combat hypovolemic shock and had no manifestations of cardiac injury. Fluid replacement principles used in the treatment of crush injury should be followed, as there may be extensive muscle injury after a lightning strike. Patients should be on ECG monitor for at least 24 hours, as significant arrhythmias may occur. The electri-cal burns are managed just like other burns.