[Hit by lightning out of the blue].

HISTORY AND CLINICAL FINDINGS: A group of six hikers were hit by lightning out of the blue sky. The biggest harm was done to a 29-year-old man (size: 190 cm) while walking along a high spruce. He experienced a seizure with consecutive sinus tachycardia and hypertensive dysregulation. One year later he still complained about reduced physical strength. The other five hikers had less severe injuries.

INVESTIGATIONS: Burns were detectable in five of six patients. Elevated creatine kinase and myoglobin were indicative for myolysis. Renal parameters were normal.

DIAGNOSIS, THERAPY AND COURSE: All patients were treated with intravenous fluid and electrolyte substitution during transport to hospital. Two patients were additionally treated with metroprolol.

CONCLUSION

Cardiac arrhythmias, usually tachycardia, myolysis, and seizures require early treatment with beta blockers, sufficient fluid supply, and antiepileptics. In patients with cardiac arrest after a lightning injury immediate cardiac resuscitation is crucial.