Archive for the ‘Lightning’ Category

LIGHTNING – THE BEAUTY AND THE BEAST

March 7, 2007

Lightning # 8 – Emergency Care – Hospital

Further Office Evaluation:  If seen in the ER or by FP after the event:

Continue O2 & IV
EKG & continuous monitoring
Labs:   
electrolytes & calcium, magnesium
CBC
CK & CKMB & myoglobin
BUN & Cr
Coagulation profile
ABG
U/A for urinary myoglobin
Consider CXR, CT head, C-spine series or CT of the cervical spine
Consider EEG (long-term)

For more detailed information about lightning and lightning-related injuries see the Wilderness Medicine Newsletter, Lightning – Beauty & the Beast, July/August 2003.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

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LIGHTNING – THE BEAUTY AND THE BEAST

March 3, 2007

Lightning # 7 – Emergency Care – Prehospital

Emergency Care for a Lightning Strike Victim – At the scene:

Survey the scene:

For immediate danger to you, others, and the victim.

Primary Survey:

Are they CONSCIOUS?
Are they BREATHING?  —>  If not, give ARTIFICIAL RESPIRATION!
Do they have a PULSE?  —>  If not, begin CPR!

Secondary Survey:

Vital Signs:

Paying particular attention to level of consciousness.
Monitor every 5 minutes until conscious and coherent.

Physical Exam – needs to be detailed:

Skin – check for burns.
Check ears for blood in the canal, and look for Battle’s sign.
Evaluate for spinal injuries.
Evaluate for sprains/strains and fractures.
Monitor peripheral pulses.

Evacuate— force fluids to help prevent late complications.
   
Treat Injuries & Transport:

Protect Airway
Protect Spine
O2 – NC at 6lpm
IV – NS at 500 – 1000cc/hr

For more detailed information about lightning and lightning-related injuries see the Wilderness Medicine Newsletter, Lightning – Beauty & the Beast, July/August 2003.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

LIGHTNING – THE BEAUTY AND THE BEAST

February 28, 2007

Lightning #6 – Prevention

“30 – 30” rule:

When you see lightning, count the time from the flash until you hear the thunder.
Speed of light – 186,000 miles per second.
Speed of sound – 700mph = 1000’/sec, or it travels 1 mile in 5 seconds.
Each 5 seconds between flash and thunder is 1 mile away.
If the time is 30 seconds or less, seek safe shelter or do a lightning drill.
Wait 30 minutes until after the last thunder clap before leaving safety.

Imminent Danger – Hints that you are about to be struck by lightning:

Hair standing up or tingling skin.
Light metal objects vibrating or seeing a corona discharge.
Hearing a crackling or “kee-kee” sound.

On the water or in the water:

If possible, get off the water; the risk is lightning and the squall line.
Get at least 100 yards back from the water’s edge.
Do not seek shelter under trees or open-roofed shelters without walls.
Risk of a direct strike is greater in salt water than fresh water.
If you have to stay on the water, put on life jackets.
Prepare for the winds of the squall line and the potential to be capsized.
If in a boat, sit in the center and stay away from the mast and metal shroud lines.

For more detailed information about lightning and lightning-related injuries see the Wilderness Medicine Newsletter, Lightning – Beauty & the Beast, July/August 2003.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

LIGHTNING – THE BEAUTY AND THE BEAST

February 24, 2007

Lightning #5 – Prevention

Prevention of a lightning strike & resulting injury:

When a thunderstorm approaches – go inside.
If in the outdoors, avoid the areas most likely to be struck:
 Anything high: mountain tops, hilltops, tall trees, towers.
 Anything metal: ski poles, pack frames, bicycles, fences.
Do not sit under trees to protect you from the rain.
Do not get under shelters that only have roofs.
 Get small, get low, do a lightning drill.
If on water, Get Off.  When on water, you are the highest object around.
Get at least 100 yards away from lakes, ponds, rivers, streams, the ocean.

Lightning drill:

Put on your rain gear and prepare for foul weather.
Get below tree line; if not possible, get away from summits and ridges.
Get away from anything tall– the tallest tree in the woods, towers.
Get away from the water’s edge, at least 100 yards.
Spread the group out; do not hold hands or sit back-to-back.
Sit on something insulated, such as an ensolite pad, with your legs crossed.
 Try to have only one point of contact on the ground.
 Try to avoid being a conductor of the ground current.

For more detailed information about lightning and lightning-related injuries see the Wilderness Medicine Newsletter, Lightning – Beauty & the Beast, July/August 2003.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

LIGHTNING – THE BEAUTY AND THE BEAST

February 21, 2007

Lightning #4 – Lightning-Related Injuries

Permanent sequelae:

Sleep disorders – Irritability
Fine psychomotor function difficulty – Sympathetic nervous system dysfunction
Paresthesias – Atrophic spinal paralysis
Generalized weakness
Post-traumatic stress disorder

Psychological dysfunction:

Memory disturbance – short term
Concentration disturbance – loss of focus, easily distracted
Difficulty coding new information
Difficulty accessing stored or old information
Cognitive powers – decreased mental manipulation, decreased problem-solving
High executive functioning – decreased multitasking

Behavior issues:  

Emotional liability
Sleep disturbance
Phobic behavior
Personality change

The Goal of Prevention – Don’t be a Conductor!

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

 

LIGHTNING – THE BEAUTY AND THE BEAST

February 17, 2007

Lightning #3: Lightning-Related Injury

Injury can be caused by:

Direct effects of electricity on the nervous system.
Heat that is caused by the resistance of the current across or through the body.
Concussive effect of the shock wave of thunder.
Explosive force on other objects can hurl debris.  Water – steam expands 1700x’s.

Lightning-related injuries:

Minor: 

Confusion  – Amnesia ( hours to days )
Temporary deafness – Temporary blindness – Temporary loss of consciousness
Cutaneous burns – Contusions – minor blunt trauma & injuries
Paresthesias – Muscular pain
Tympanic membrane rupture
Mild transient hypertension
Cognitive damage to learning, thinking, or memory

Moderate: Temporary – to – permanent

Eyes – cataracts
Disoriented  – combative – comatose
Motor paralysis
Mottled skin
Diminished or absent pulses – Hypotension
Fractures – Spinal shock – spinal fractures
Temporary cardiopulmonary standstill or Respiratory arrest – can lead to cardiac arrest
Seizures
1st and 2nd degree thermal burns
Ruptured tympanic membrane – Hemotympanum – may indicate basilar skull fracture

Severe:

Cardiac arrest – asystole, ventricular fibrillation
Direct brain damage
Hematologic disorders – DIC
Basilar skull fracture

For more detailed information about lightning and lightning-related injuries see the Wilderness Medicine Newsletter, Lightning – Beauty & the Beast, July/August 2003.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

LIGHTNING – THE BEAUTY AND THE BEAST

February 14, 2007

Lightning #2 – The Physics of Lightning

The Physics of Lightning:
Direct current electricity.  ( DC, not AC like the current that feeds our houses.)
Very high voltage and high amperage: can exceed 100 million volts, 100,000 amps.
Very hot, 50,000C, hotter than the surface of the sun.
Very short duration – instantaneous; milliseconds.
Produces Ozone, O3, that protects the earth from the deadly effects of ultraviolet light.
Electricity travels over the surface of objects, unless there is an internal conductor.
Internal conductors – nerves & blood vessels (contain an electrolyte solution).

Formation of lightning:
Vertical acceleration of moist air, forms ice crystals, causes charge separation.
Areas of positively and negatively charged atoms occur throughout the cloud head.
Electrical discharge to stabilize charges created in cumulonimbus clouds.
The base is negatively charged with a positive shadow forming on earth.
Typically, lightning occurs under and along the leading edge of the cumulonimbus cloud.
It can occur as far as 10 miles away, a strike “out of the blue.”
Can travel horizontally over 60 miles; the longest recorded to date was at 118 miles long.

Lightning strike can be: 
Direct strike or streamer current.
Splash or surface arc.    
Step voltage or ground current.
The principle is don’t be a conductor!

For more detailed information about lightning and lightning-related injuries see the Wilderness Medicine Newsletter, Lightning – Beauty & the Beast, July/August 2003.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

LIGHTNING – THE BEAUTY AND THE BEAST

February 10, 2007

Lightning #1 – Lightning Statistics

Severe weather is interesting yet frightening, beautiful yet destructive, and always fascinating. It makes great news and never fails to attract our attention.  With this in mind, we thought it would be a good idea to address an aspect of severe and potentially life-threatening weather, thunderstorms.

Lightning strikes the USA approximately 100 times per second or 20 – 30 million cloud-to-ground lightning flashes per year.

Death caused by lightning is second only to floods for weather-related deaths, according to the National Weather Service, with an average of approximately 100 deaths per year over the past 40 years. 

Lightning strikes have a 10% – 20% mortality rate with a 70% – 80% morbidity rate. 

The odds of being struck by lightning in a year are 1/700,000 or a lifetime prevalence of 1/3000. 

USA Weather-Related Deaths as per the National Weather Service: (over 40 years)
#1  Floods – 150/year
#2  Lightning – 100/year  (500 – 1000 injuries per year)
#3  Tornado –  68/year
#4  Avalanche –  50/year
#5  Hurricane –  16/year

For more detailed information about lightning and lightning-related injuries, see the Wilderness Medicine Newsletter, Lightning – Beauty & the Beast, July/August 2003.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.