The majority of patients with lightning strike injuries require admission to a center with appropriate capabilities for providing specialized, comprehensive care. Conditions associated with serious mortality and morbidity include cardiorespiratory arrest, cranial burns, leg burns, ECG changes and dysrhythmias, any CNS lesions or loss of consciousness, any neurologic injuries without rapid resolution, and myoglobinuria. 14 Consultation with trauma surgery, neurosurgery, cardiology, and neurology services may be indicated. All pregnant patients require admission for fetal monitoring and ultrasound fetal assessment.

Those with minor injuries who show improvement within the first several hours after a strike may benefit from admission for careful monitoring of neurologic and cardiovascular status, due to the potential for delayed sequelae. Patients who have no neurologic deficits and only minor abnormalities found on a thorough examination may be monitored in the emergency department and discharged with adequate follow-up. Consider neurologic; ear, nose, and throat; and ophthamologic referral for evaluation of potential long-term sequelae in all victims.

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