Low voltage - <1000 V

High voltage - >1000V

Extremely high voltage - lightning strikes

• Direct - usually fatal​

• Sideflash - Discharge of current from structure struck by lightning through the air or ground

• Causes extensive deep muscle damage

  • Bone has high resistance, therefore it heats and causes burning from within​

• Fasciotomies may be required​

• Myoglobinuria and haemoglobinurea should be managed by maintaining a high urine output (2ml/kg/hr)

  • Consult critical care specialists about use of mannitol or sodium bicarbonate ​if urine output targets not met in spite of maximal fluid resuscitation

Cardiac arrest

Suggestion of current crossing the mediastinum from entry and exit wound

Abnormal 12-lead ECG