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Lightning injury with multisystem involvement

                                                 Dr.Ashwini Ramesh Patankar,  Dr D Y Patil Hospital and Medical College, India  

Introduction

Lightning leads to multiple fatalities, trauma and disability: cardiac arrythmia, arrest, burns, stroke, kidney injury and leading to death. We present a case with lightning injury with multiple complications and management.

Case

A 40-year-old female farmer presented with transient loss of consciousness, vomiting, burns over neck, abdomen and decreased hearing after being struck by lightning.

On arrival she had palpitations, heart rate of 140/min irregularly irregular, blood pressure was 90/50mm Hg. Skin over neck, breast, abdomen and groin showed second degree burns. Electrocardiogram showed atrial fibrillation after which the patient was cardioverted to rate controlled atrial fibrillation. On regaining consciousness patient had bilateral sensorineural hearing loss. MRI brain(venogram) was suggestive of venous sinus thrombosis. Audiometry showed profound sensorineural hearing loss bilaterally. Cardiac enzymes showed elevation. Post cardioversion ECG showed T wave inversions in all leads, suggestive of myocardial ischemia. Urine showed protein, blood and myoglobulin. Her CPK levels were normal. Thrombophilia profile showed protein c deficiency. Patient was started on Amiadarone, low molecular weight heparin and later switched to oral anticoagulant on discharge.

Discussion and conclusion.

Lightning injuries have multi-systemic manifestations. In cardiovascular system they can cause cardiac depolarization, asystole, atrial and ventricular arrhythmias. Multiple mechanisms are coronary artery spasm, catecholamine effects, thermal damage, ischemia. Usually, these atrial arrythmias are known to autorevert, but here, the patient being hemodynamically unstable, was cardioverted. Interesting finding in patient was bilateral sensorineural deafness. Usually, it is secondary to rupture or damage to tympanic membrane but occasional sensorineural hearing loss reported due to either vascular or structural damage to inner ear. Van Haren RM et al suggested hypercoagulable state during recovery from electrical burns. In this case it could have been the cause of cerebral venous sinus thrombosis.