ENVIRONMENTAL

ResponseDirect - victim struck directly
Side flash - Nearby object struc and current traverses the air to hit victim/s
Contact strike - Lightning hits object person is holding, current then transmitted to ground via victim (eg: indoor telephone)
Ground current - Lightning hits the ground and is transferred through the ground to nearby victim. Current enters foot closer to strike and extits through more distal foot (“step voltage”)

ResponseAsystolic arrest - massive depolarisation. May recover if secondary hypoxic arrest prevented
Keraunoparalysis - Lightning induced (usually lower limb) paralysis with vascular spasm, flaccidity, and loss of sensation. Impalpable peripherle pulses with blue, mottled limb. Usually self limiting.
Lictenberg Figures- Feathery cutaneous burns

Neurologic deficits - Temporary extremity paralysis, LOC, confusion, amnesia.
Burns
Cataracts, delayed
TM rupture (50%)
Posterior shoulder dislocations

ResponseLichtenberg figures (ferning/feathring) = Pathognomonic for lightning strike!
Burns from belt buckle

ResponseEye complications, especially cataracts
Delayed less common - parkinsonism, seizures, ataxia
Burns

ResponseCTB ? CNS injury
ECG ? arrhythmia
CK ? rhabdo
EUC ? potassium
Urine dip ? Myoglobinuria
Troponin ? AMI, nerve conduction studies, audiometry