Im just going to copy and paste the info from this article, its is by Dr Mary Ann Cooper, ive met her and her knowledge of lightning strikes on humans is unmatched.
Lightning injury is a neurological injury, affecting all 3 parts of the nervous system.
Brain – Neurocognitive changes, sleep disturbance, personality change, seizures, learning disability, postconcussive headaches, nausea, attention deficit, distractibility
Autonomic nervous system - Regulation of blood pressure and cardiac response (positive tilt test results, dizziness, hypertension), GI insult, impotence, sympathetically mediated pain syndromes
Peripheral nervous system - Chronic pain, sensory problems
Often, these injuries are ongoing and not easy to quantify or to treat.
Survivors tend to be young, employed, family people who suffer loss of income and disability and become a large cost for the community.
Although lightning injuries during recreational activities predominate in developed countries, nearly one third of lightning injuries are work-related, on-the-job injuries.
In more agrarian societies, the proportion of work-related injuries and deaths to those that occur in other settings is probably higher.
The most common days of injury in the United States are on Saturdays, Sundays, and Wednesdays, probably reflecting the recreational activities on the weekends. The most common time of day to be injured by lightning is from noon to 6 pm, with 6 pm to midnight following, related to not only when thunderstorms occur but also when people are most likely to be outdoors
Physical presentation may vary from mild disorientation with no immediate physical signs to cardiac arrest (the only direct cause of death) and anoxic brain injury.
Cardiorespiratory symptoms
Cardiorespiratory arrest is the only known direct cause of death but is still uncommon. Lightning acts as massive defibrillation, sending the heart into momentary asystole, from which the heart often spontaneously recovers. The autonomic nervous system control has also been shown to be affected by lightning. In addition, for unknown reasons, respiratory arrest usually lasts longer than the initial cardiac arrest; thus, a secondary cardiac arrest from either hypoxia or other unknown causes may occur.
Many changes may be observed on the ECG, but the most commonly reported is QT prolongation, which generally resolves over several months and does not commonly require treatment. The indicated treatment depends on the resulting abnormality.
Neurological symptoms
Patients who are awake are usually able to carry on reasonably appropriate social conversation. However, they may develop disabling neurocognitive deficits similar to those of people with blunt head injury, which may not be apparent until survivors attempt to return to their previous work and are unable to process new information, organize their activities, and multitask.
Acute pain, numbness, or other dysesthesias may be reported. Chronic pain syndromes may develop from lightning injuries and may be due to nerve injury, sympathetic nervous system injury, spinal column injury, or other causes.
Sympathetic nervous system injury may cause vascular spasm, temporary paralysis and mottling of an extremity (keraunoparalysis), transient hypertension, and late problems with positive tilt test results, vertigo or dizziness, hypertension, and pain syndromes.
If the patient is unconscious, suspect and investigate anoxic brain injury or underlying brain injury.
Dermatological symptoms
Deep burns: Because lightning usually has extremely brief contact with the skin, deep burns are rare. Should burns occur, treat them like any other high-voltage injury, including investigating for myoglobinuria.
Superficial burns: Burns may appear linear (often secondary to vaporized sweat or rainwater), punctate, or in pathognomonic fernlike patterns. Burns may also be secondary to heating metal, such as necklaces, coins in the pocket, or cleats on the bottom of athletic shoes.
Blunt injury
Consider concomitant myoglobinuria if blunt injury is present.
Fractures are uncommon and occur much more rarely in lightning injuries than in high-voltage injuries. Being thrown tens of yards because of intense muscle contraction is frequently reported. If the patient has a history of a fall or being thrown a distance, investigate for fractures and blunt injuries.
Organ contusions, pulmonary hemorrhage, and cardiac contusions have been reported but are rare.
The ear is the sense organ most commonly injured by lightning. Tympanic membrane rupture is common and may occur from concussive or explosive force, direct current entry (often associated with burns to the canal or disruption of the ossicles), or from basilar skull fracture.
Nearly every type of eye injury has been reported with lightning injury, including cataracts, macular holes, retinal separation, and iritis. Cataracts may be a late sequela of lightning injury, as are chronic pain syndromes, sleep disturbance, and severe headaches.
Causes: The primary risk factor is the failure to acknowledge that lightning poses a threat. Lack of knowledge of lightning injury and its mechanisms also contributes to the risk. Many people try to finish one more inning or wait until rain begins before seeking shelter. This is often too late because lightning frequently jumps as far as 10 miles in front of the thunderstorm clouds. The interstrike distance, depending on the local terrain and geography, may be as far as 5 ± 5 miles, for a range of 10 or more miles from the last seen stroke.
The primary physical risk factors that determine a strike are isolation, height, and narrowness of the tip of the object facing the cloud. Only the first two apply to people.
The following positions pose the highest risk of injury: (1) standing close to any high object (flagpole, tree, antenna) or being the highest object in the area, (2) being close to water (swimming pool, beach, boat, dock), and (3) being connected to or close to plumbing or wires inside a building.
Risk factors include being out in bad weather without knowing the forecast, not paying attention to the weather, or not having or following an evacuation plan.
Certain geographic areas are more prone to lightning, such as mountain ridges (between 3 pm and 5 pm), parts of Florida and the Gulf Coast, the Eastern Seaboard, and the major river valley areas of the Midwest.
Although lightning during recreation accounts for the most injuries, a large number of lightning injuries, as many as one third in some studies, are work related. In addition, a measurable number of injuries occur inside structures every year.
2007-03-12 17:58:56
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answer #5
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answered by Kevin B 4
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