Case Study 24

The Scenario: When Lightning Strikes

The Setting

I was hiking with a friend through the Uinta Mountains in Utah, cruising the Highline trail, heading toward Porcupine Pass.  Graying clouds were building to the west with the hint of a thunderstorm, but we ignored the threat--our itinerary did not accommodate delays. Porcupine topped off at 11,600ft, exposing us to the building clouds, gusty winds, deep low rumbles of thunder, and occasional spits of rain. We moved quickly up and over the gap in the ridgeline. 

West of the pass is one of the broad high and beautiful Uinta alpine meadows; two miles of grass and flowers before we would walk into the krumholtz. The storm was clearly upon us. It beat us with hail, staggered us with strong gusts, and startled us with the flash and bang of electrical activity. We had a brief conversation about stopping and assuming a lightning position. Our decision was to seek the shelter of the trees. We hurried along the trail, feeling incredibly vulnerable.

The flash was startling and disorienting. Wind slapped my face. I was next aware of my friend asking if I was hurt. I had mud in my hair, on my face, in my mouth, and under my glasses. I stood up and shook off the embarrassment. My companion wasn't interested in a detailed patient assessment; safety was belatedly a priority. He hustled me toward the treeline, laughing at my mud-plastered appearance.

SOAP Report

Subjective

The patient is a 19-year-old male who fell from standing to the ground while hiking when startled by a nearby lightning strike. He was stunned for a few minutes then able to walk another half mile to shelter.

Objective

The patient is presently sitting. He is complaining of pain in his left shoulder, hip, and knee. There is a mud-encrusted abrasion on the left knee and hip and mild swelling to the left shoulder. The patient is able to walk and has full range of motion in the shoulder. CSM is good in the left hand. No other injuries found. Patient did not lose consciousness. There is no evidence of any electrical burns. 

Vital Signs
TIME

1400

LOR

A+Ox4

HR

72, strong, regular

RR

20, easy, regular

SCTM

pink, warm, dry

B.P.

good radial pulse

Pupils

PERRL

not taken

 

History

Symptoms:

Pt states he can hear and see normally. Denies any symptoms other than the pain in hip, shoulder and knee.

Allergies:

Denies

Medications:

Ibuprofen 400mg at 0800 and 1200 today for muscle aches unrelated to this event.

Pertinent Hx:

None relevant

Last in/out:

Pt is well-hydrated (3 liters water today) with normal clear urine and normal bowel movements.

Events:

Pt took a hard fall from standing while hiking.   

Stop ...

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