Lightning-strike-induced acute lung injury: a case report

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Cardiology

Background:

• Lightning strike is a high-voltage electrical injury associated with significant morbidity and mortality.
• Respiratory complications like pulmonary edema, contusion, ARDS, and hemorrhage are common after lightning strikes.
• Patients sustaining lightning injuries should be evaluated as multiple trauma victims due to diverse injury mechanisms.

Observation:

• A 19-year-old presented with amnesia, disorientation, dyspnea, abdominal pain, lung contusion, and myopathy after a lightning strike.
• Initial vital signs revealed hypotension (80/50 mmHg), tachycardia (110/min), and hypoxia (85% SpO2).
• Imaging showed bilateral lung contusion, pleural effusion, global cardiac hypokinesia, and reduced ejection fraction (20-25%).

Findings:

• The patient was admitted to the ICU and received supportive care, including oxygen, hydration, antibiotics, steroids, and invasive cardiac monitoring.
• Clinical and radiological improvements were observed, leading to hospital discharge on day 10.
• Follow-up imaging on day 20 post-discharge showed complete resolution of thoracic abnormalities.

Implications:

• This case underscores the critical importance of a comprehensive trauma evaluation for lightning strike victims.
• Aggressive supportive management in the ICU can lead to favorable outcomes even in severe lightning-induced multi-system trauma.
• Early recognition and management of respiratory and cardiac complications are vital for survival and recovery.