Struck Down: Lightning Medicine for the Frontline Provider

A summer thunderstorm rolls across a crowded soccer field. Four people are down - one apneic and pulseless with fixed dilated pupils, a child with a femur fracture and no distal pulse, a teenager with chest pain, and a pregnant woman with abdominal pain. Who do you treat first? Who has the best chance of survival? How do you know who’s safe to discharge?

Lightning strikes demand rapid triage, multidisciplinary coordination, and familiarity with a unique spectrum of injuries rarely seen in routine practice. This case-based, high-yield lecture is designed to equip emergency physicians with the clinical reasoning and practical knowledge needed to manage lightning strike victims, especially in mass casualty settings.

By the end of this lecture, learners will be able to (1) differentiate “reverse triage” from standard “mass casualty triage”, (2) name the two most common causes of death by lightning strike, and (3) identify 1 cutaneous and 1 otolaryngologic finding as a result of a lightning injury.