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You are seeing a 15-year-old male who was sitting in his backyard when he says he was struck by lightning. He had no loss of consciousness and is asymptomatic at this time. A thorough physical exam reveals very mild tachycardia, otherwise normal vital signs, and no other abnormalities.
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June 12, 2024 at 5:16 pm
D) Lichtenberg figures are pathognomonic for lightning strike injury
Lightning is DC current. Household current is AC. Lightning strike injuries are high voltage, but generally extremely brief. Besides by type of current, electrical injuries are also classified as low voltage (household current) or high voltage (power lines). The most common initial dysrhythmia causing sudden death from a lightning strike is asystole. Direct strike is uncommon; injuries occur more often from ground current transmitted through the ground to the person. Lichtenberg figures, branching feathery skin lesions, are pathognomonic for lightning injury. An asymptomatic patient probably wasn’t directly struck by lightning but could have had a lightning injury. He should be thoroughly evaluated, and most would recommend at least an ECG and possibly a period of cardiac monitoring for several hours.