Lightning is result of discharge of electric current from the clouds to the earth. Thunderstorm  produce a powerful natural electrostatic discharge which results in lightening. Energy is liberated along the tract of current and most of which is converted into light. Thus, the abrupt electric discharge due to lightning is accompanied by the emission of visible light and other forms of electromagnetic radiation. The electric current is direct with a potential of 1000 million volts or more. Lightning may injure or kill a person by a direct strike, a side-flash, or conduction through another object [1-2]. Lightning may cause a great variety of injuries in the skin and cardiovascular, neurological and ophthalmic systems, such as diplopia, cataract, hearing impairment by ruptured tympanic membrane, and rhabdomyolysis [3-5].

CASE REPORT

A 22-year female patient presented to emergency surgery department with A/H/O flash burns following lightening  with H/O Loss of Consciousness ~ 10-15 min with No H/o Ent bleed and loss of hearing. On Examination Patient was conscious, cooperative, well oriented to time, place and person with  Pulse Rate: 90 bpm ,Blood Pressure: 128/80 mm Hg,O2 saturation: 94% on Room Air.

• Central Nervous System: B/L Pupils equal and reactive to light with Glasgow Coma Scale:E4V5M6 15/15

• Respiratory System: B/L vesicular breath sounds

• Cardiovascular System: S1 S2 normal; No added sound

• Per Abdomen: Soft, Non-Tender, No Guard, Rigidity,Rebound Tenderness,.Bowel Sounds: present

• Local Examination: Presence of superficial to deep burns over chest, abdomen, Right thigh, leg and popliteal fossa region

• Blood Investigations: Haemoglobin: 10.8 g/dl

• Hematocrit: 31.1%

• White Blood Cells: 6.45 X 10³

• Platelet count: 246 X 10³

• Prothrombin time/International normalised ratio: 14.1/1.08

• Random Blood Sugar: 98mg/dl

• Blood Urea Nitrogen: 10mg/dl

• Creatinine: 0.52 mg/dl

Figure 1: Showing Superficial to Deep Burns Over Chest

Figure 2: Abdomen, Thigh

• Na/K/Cl: 137/4.33/103

• Urine Routine/Microscopy: Normal

• Urine for Myoglobin: Below 21 (0-1000 micro gm/l)

• NCCT Head: Grossly normal study

• Ultrasound E-FAST: Negative

• Chest X ray-PA: No evidence of hemo/pneumothorax

• ECG: Normal Sinus Rhythm

Lightning causes various types of injury and death and approximately a third of all lightning strikes are fatal [6]. 

Lightning causes injury through five mechanisms [7]:

• Direct Strike: lightning directly strikes a person who gets the whole charge. Mortality is very high. 

• Ground Current (Step Voltage): lightning hits the ground, a tree or pole and uses it as a conductor to strike the victim. 

• Flash Discharge (Side Splash): This is the most frequent mechanism. Lightning jumps from a primary strike object on to a nearby one. 

• Contact Strike: a person is touching an object which has been struck by lightning.

• Blunt Trauma: a person is thrown violently from the lightning strike or from the explosive force that occurs as surrounding air is superheated and rapidly cooled. It is secondary to lightning strike     Cause of death- Cardiac or respiratory arrest due to arrhythmias

Skin injuries from electricity present deep and extensive tissue necrosis which is frequently associated with compartment syndrome, whereas injuries from lightning usually involve superficial and feathering burns (Lichtenberg figures, pathognomonic of lightning injury) with, to a lesser extent, associated compartment syndrome [8].

Lichtenberg figures are also known as Lichtenberg’s flowers or arborescent or filigree burns; they are characterized by multiple, superficial, irregular, tortuous arborescent markings on the skin resembling the branches of a tree. This fern-like pattern of erythema on the skin is usually found over the shoulders or the flanks. These marks are very rarely seen [1,9].

But in some cases, it may not present as Lichtenberg figures and present as superficial to deep burns.

1. Reddy, K.S.N. The essentials of forensic medicine and toxicology. 22nd ed. Hyderabad: Devi K.S., 2003, pp. 273–4.

2. "Lightning." BrainyEncyclopedia, http://www.brainyency clopedia.com/encyclopedia/l/li/lightning.html. Accessed 27 May 2006.

3. Grover, S. et al. "Lightning and electrical injuries: neuroophthalmic aspects." Semin. Neurol., vol. 15, no. 4, 1995, pp. 335–41.

4. Fahmy, F.S. et al. "Lightning: the multisystem group injuries." J. Trauma, vol. 46, no. 5, 1999, pp. 937–40.

5. Gluncic, I. et al. "Ear injuries caused by lightning: report of 18 cases." J. Laryngol. Otol., vol. 115, no. 1, 2001, pp. 4–8.

6. Sheela, S.R. et al. "An unusual case of lightning injury." Indian Pediatr., vol. 37, no. 8, 2000, pp. 802–3.

7. Edlich, R.F. et al. "Burns, lightning injuries." Med. Spec. Plast. Surg. Burns., 2004.

8. Matthews, M.S. et al. "Plastic surgical considerations in lightning injuries." Ann. Plast. Surg., vol. 39, no. 6, 1997, pp. 561–5.

9. Mukherjee, J.B. Forensic medicine and toxicology. vol. I, 2nd ed. New Delhi: Arnold Associates, 1994, pp. 467–9.