Lightning Strikes Claim Lives in Bihar and Gujarat: Uncovering the Medical Realities of Lightning Injuries
Aug 23, 2024
August 21, 2024
【Guide】
Recent deadly lightning strikes in Bihar and Gujarat have raised alarms about the rising toll of lightning injuries. These tragic events underscore the need for better public awareness and preventive measures. A review of the pathology of lightning injuries offers insights into their unpredictable nature and how medical science is grappling with these lethal phenomena. By combining recent news with the latest research, this article explores the impact of lightning on public health and the importance of understanding trauma mechanisms for better outcomes.
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01 The Rising Death Toll from Lightning Strikes in Bihar and Gujarat
The recent lightning strikes in India have led to tragic losses. In Bihar’s Nawada district, six people died in separate incidents, with the Chief Minister offering ex-gratia payments to the bereaved families. Meanwhile, in Gujarat, two agricultural workers lost their lives when lightning struck Jamnagar during severe weather. These events highlight the unpredictability of lightning strikes and their capacity for devastating consequences. State governments have responded by issuing advisories urging people to seek shelter during thunderstorms.
02 What We Know About Lightning Injuries: Insights from Research
Figure 1: Injuries and deaths from lightning
The paper ‘Injuries and deaths from lightning’ by Ryan Blumenthal reviews the pathology of lightning injuries in depth. The study explains that approximately 24,000 deaths and 240,000 injuries occur annually due to lightning strikes worldwide. It describes how lightning injuries can result from direct strikes, side flashes, ground currents, and contact voltage, each presenting different risks and injury patterns. In cases where individuals are struck, the mortality rate is as high as 30%. The paper highlights how the severity of injury depends on the path the electric current takes through the body, which can lead to cardiac arrest, brain damage, and severe burns. These statistics align with the recent events in Bihar and Gujarat, where multiple fatalities were recorded. This introduction to lightning-induced injuries sets the stage for understanding their physiological effects at the cellular level, as detailed in the next study.
Figure 2: Cell death due to electroporation – A review
The second study ‘Cell death due to electroporation – A review’ explores the phenomenon of electroporation, which occurs when cells are exposed to strong electric fields, such as those generated by lightning. The study shows that high-voltage electroporation can cause irreversible damage to cell membranes, leading to cell death. This effect is seen most prominently in lightning injuries, where the electricity disrupts both skin and deeper tissues, causing organ failure. The study states that in high-voltage injury cases like lightning strikes, the likelihood of cell death increases dramatically, with affected tissues often requiring surgical intervention. The paper underscores that while mild electroporation can be reversible, severe cases often result in permanent damage or death. Understanding how electric shock impacts cellular structures is crucial in managing subsequent organ failure, such as the cardiac issues discussed in the following case report.
Figure 3: A CASE REPORT: REVEALING DELAYED CARDIAC PHENOMENON IN ELECTRICAL
The third paper, ‘A CASE REPORT: REVEALING DELAYED CARDIAC PHENOMENON IN ELECTRICAL’ by K Biering, details a case of a 28-year-old male who suffered a myocardial infarction three days after a high-voltage electric injury. The report highlights that 87% of patients with electrical injuries develop third-degree burns, and about 43% experience delayed cardiac complications like myocardial infarction. In this specific case, the patient exhibited no immediate cardiac symptoms but later developed significant heart issues, which were only detected through continuous monitoring. The case emphasizes the importance of ongoing cardiac monitoring for survivors of electrical injuries, such as lightning strikes, as the delayed onset of complications can be life-threatening. This delayed response mirrors the complexity of managing electrical injuries in vulnerable populations, as highlighted in the next study focusing on pediatric burns.
Figure 4: Epidemiological and Clinical Characteristics of 5,569 Pediatric Burns in Central China From 2013 to 2019
The fourth study ‘Epidemiological and Clinical Characteristics of 5,569 Pediatric Burns in Central China From 2013 to 2019’ offers valuable insights into burn injuries in children, 1.17% of which were caused by electrical burns. While scalds accounted for the majority of burns (90.63%), the study found that electrical burns had the highest rates of disability and mortality. For children suffering from electrical burns, the median total body surface area (TBSA) affected was 6%, and full-thickness burns were common. The study reported that children with electrical burns had a higher incidence of complications such as pneumonia (19.2%) and shock (7.6%). The data stresses the need for rapid emergency care and surgical interventions for these types of injuries, mirroring the severity of lightning-induced trauma. However, adults are not exempt from these complications, as seen in the subsequent study analyzing severe electrical injuries in adult populations.
Figure 5: Electrical injuries in adult patients – 3 years overview
The fifth paper ‘Electrical injuries in adult patients – 3 years overview’ by D Lee et al. examines 23 cases of severe electrical injuries treated at the Clinical Emergency Hospital in Bucharest, Romania. The study reveals that 87% of the patients suffered third-degree burns, and 43% died from complications associated with their injuries. It highlights that electrical injuries frequently affect the upper body, particularly the thorax and limbs, which is consistent with lightning injuries that strike similar areas. The study found that over 30% of patients required mechanical ventilation due to the severity of their injuries, with an average hospitalization period of 34 days. These findings reinforce the critical need for immediate and specialized medical care in lightning strike cases, where the complexity of injuries demands multidisciplinary treatment. Having explored the outcomes of burn injuries in both children and adults, it is crucial to consider novel treatments that can address these challenges, as shown in the next section on how to treat such injuries.
03 How to Treat Lightning-Induced Injuries
Figure 6: How to Alleviate Cardiac Injury from Electric Shocks at the Cellular Level
The study ‘How to Alleviate Cardiac Injury from Electric Shocks at the Cellular Level’ by S. Virani et al. investigates the cellular damage caused by electric shocks, including those induced by lightning. It highlights the potential of Poloxamer 188 (P188), a copolymer that protects cell membranes, in reducing cardiac cell death following exposure to high-voltage electric fields. In laboratory settings, P188 was shown to decrease cell death by up to 1.7 times when administered shortly after exposure to pulsed electric fields (PEF), particularly nanosecond and microsecond PEF shocks, which mimic the effects of lightning-induced injuries. The study further reveals that without intervention, electric shocks can cause irreversible cell membrane damage, resulting in a 97% mortality rate among affected cells within just 8 hours. P188, when applied in concentrations ranging from 0.2% to 1%, significantly improved survival outcomes by stabilizing the membrane and preventing further electroporation. These findings underscore the importance of early intervention in lightning-induced cardiac injuries, with potential implications for improving the prognosis of survivors through timely medical treatment. To address severe burns often seen in lightning strike survivors, the next paper investigates how innovative treatments like nanotechnology can aid in skin repair.
Figure 7: New Nanotechnologies for the Treatment and Repair of Skin Burns Infections
The study ‘New Nanotechnologies for the Treatment and Repair of Skin Burns Infections’ by Mofazzal Jahromi et al. explores how cutting-edge nanotechnology is revolutionizing the treatment of severe burn injuries, including those caused by lightning. The research emphasizes the efficacy of silver nanoparticles in preventing infections in burn wounds, which are highly prone to bacterial invasion. Statistics reveal that up to 60% of burn-related deaths are directly linked to infections, highlighting the critical role of timely and effective wound management. The study demonstrated that silver nanoparticles, when incorporated into wound dressings, reduce microbial growth by 99.9%, significantly lowering the risk of sepsis. Furthermore, these nanoparticles enable localized drug delivery, preventing systemic antibiotic exposure, which reduces the risk of antibiotic resistance. The ability of nanotechnologies to enhance healing while minimizing infection risks makes them a vital tool in managing complex wounds caused by lightning strikes. These innovative treatments play a crucial role in reducing complications, but the importance of timely emergency response is equally critical, as highlighted in the next paper.
Figure 8: A Shocking Injury: A Clinical Review of Lightning Injuries Highlighting Pitfalls and a Treatment Protocol
The paper ‘A Shocking Injury: A Clinical Review of Lightning Injuries Highlighting Pitfalls and a Treatment Protocol’ by J. Jensen et al. underscores the complexity of lightning-induced trauma and the challenges in managing such injuries. It highlights that 75% of all lightning strike victims suffer from permanent disabilities, with cardiovascular and neurological damage being the most common. Lightning strikes have a mortality rate between 10-30%, depending on factors such as the victim’s proximity to the strike and pre-existing health conditions. The review details that approximately 50% of lightning injuries are caused by ground strikes, where the electrical current enters through one leg and exits through the other. Another 30-50% result from side flashes, while direct strikes, though rare (3-5%), have the highest fatality rate. The authors stress the importance of reverse triage, prioritizing resuscitation for those who appear lifeless, as cardiac arrest due to lightning strikes is often reversible if treated rapidly. Proper identification of injuries such as Lichtenberg figures (a diagnostic skin pattern) and the application of standard trauma guidelines are critical in preventing mismanagement.
04 The Future of Lightning Injury Management and Prevention
The recent lightning strikes in Bihar and Gujarat have emphasized the need for improved public safety measures and enhanced emergency response protocols. Research has demonstrated the importance of rapid intervention, such as the use of reverse triage during rescue operations to prioritize cardiac arrest victims, which has been shown to be potentially reversible if treated promptly. The use of Poloxamer 188 (P188) to reduce cell membrane damage and improve cardiac survival rates after lightning strikes presents a promising advance in treating lightning-induced injuries.
In addition, silver nanoparticle technology has proven highly effective in reducing infection rates in burn wounds, which are common among lightning strike survivors. This treatment could be further integrated into emergency care protocols to prevent sepsis, a leading cause of death in burn victims. The evidence-based management of lightning injuries, including a focus on cardiovascular and neurological damage, has significantly advanced in recent years. Ongoing research and the adoption of these medical interventions will likely reduce morbidity and mortality associated with lightning strikes.
