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I am not aware of any formal grading system. However, any lightening strike
with LOC, CPA or respiratory arrest, arrhythmias, neurologic s/s or arcing
across heart or with major burns would be intuitively significant. I agree
that your patients' may have not been directly exposed to lightening but
may have had associated trauma from the tree limb. The parasthesias could
represent occult spinal cord injury/SCIWORA.
 
Do folks on the list routinely get MRI on kids with such complaints? I
think they minimally require admission, as you did, to rule out evolving
cord contusion.
 
The lab work for myoglobin may have been an overkill. I do not routinely
send quantitative myoglobin, CPK or renal functions if their urine
(screening) dip is negative. Myoglobinuria is rarely a cause of tubular
obstruction when present only in microscopic amounts and I don't treat it
aggressively unless grossly positive. I would serially check it if there
has been significant crush or burns.
 
Hope that helps
 
Jay Pershad
"We care for wee folks"
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> From: Marianne B. Sutton <[log in to unmask]>
>
> We had twelve kids aged 7-19 indirectly struck by lightening, in Concord
> Mass. The lightenig struck a tree located about 10 feet from the tent in
> which the children were located, the tree was brunt down and shredded
> into multiple pieces.  Most of the kids had felt some "tingling and
> numbness in hands or legs" and were thrown a few feet to yards from
> where they were at the time the lightening struck.  They had lytes, bun,
> cr, cpk, urine dips and urine for myoglobin and EKGs, and were admitted
> for observation (as recommended by a few protocols).  Everyone was fine
> in the AM, this seems like a bit of overkill, anyone have experience in
> how you grade severity of  electrical injury and outcomes?
 
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