Saturday, April 4, 2015

lightning strike

case :21 - year - old man was lying naked in a sleeping bag in his tent on the Lumbini  when a massive thunderstorm entered the region. He was ‘ ‘ jolted ’ ’ following a nearby lightning strike and had immediate pain in his shoulder. 

He presented to the emergency department with the skin findings noted in the photo here.

Punctate burns on the patient ’ side.

Question: What is the name of this skin finding that is pathognomonic for a lightning strike?

A. Kissing
B. Jellyfish
C. Feathering
D. Satellite
E. Treeing

Answer: C

Diagnosis: Feathering

Discussion: The case figure demonstrates a depressed, gray, punctuate wound on his shoulder corresponding with an entrance wound with surrounding feathering. Figure shows multiple discrete punctuate burns along the side of his body where he was in contact with the sleeping bag ’ s metal zipper. Figure reveals two depressed punctuate lesions on the lateral aspect of his foot and on the end of his great toe, corresponding with exit wounds (known as the “ tiptoe ” sign).
Cloud - to - ground lightning strikes occur approximately 30 million times each year.

These lightning strikes are associated with approximately 24 deaths and 98 injuries annually. The electrical current generated by a nearby lightning strike will preferentially flow through a person ’ s body rather than the ground. This is called “ step voltage. ” Two skin findings associated with lightning are present in this case. Feathering burns arepathognomonic of lightning and are not true burns but rather transient skin marks. Punctate burns are multiple, discrete circular burns that range in diameter from a few millimeters to a centimeter.



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