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Nursing management for lightning or electrically injured patient
Introduction: Lightning and Electrical Injuries <ul><li>The Purpose of this Presentation is to: </li></ul><ul><ul><li>Lear...
Lightning Injury <ul><li>Background: </li></ul><ul><li>Odds of being struck: 1 out of 5,000 in lifetime. </li></ul><ul><li...
Lightning Injury <ul><li>Cultural Consideration:  </li></ul><ul><ul><ul><li>South Africa:  Death by lightning is seen as a...
Lightning Injury <ul><li>Common Myths </li></ul><ul><ul><li>All people who suffer lightning injury are by direct strike.  ...
Lightning Injury <ul><li>Figure:  Dead cows lined up along a metallic fence. Lightning struck the fence, and the  current ...
Lightning Injury <ul><li>Common Myths continued...: </li></ul><ul><ul><ul><li>Lightning never strikes the same client twic...
Lightning Injury <ul><li>How Lightning Injury Impacts the Patient: </li></ul><ul><li>About 90%  of people are injured each...
Lightning Safety <ul><li>“The principle lightning safety guide is the 30-30 rule. The first “30” represents 30 seconds. If...
Electrical Injury <ul><li>Account for 1,000 fatalities per year.  </li></ul><ul><li>BURNS are one of the primary concerns....
Lightning vs Electrical Summary of  the Two Insults Secondary blunt trauma can be seen if the person is  thrown from the e...
Pictures Lightning Injury Burn  Superficial burns, note linear patten Photo credit: www.osha.gov Electrical Injury Burn Fu...
Purpose and  Research Question <ul><ul><li>  To explore the nursing management in current practice that address the long-...
Methods <ul><ul><li>Databases:  </li></ul></ul><ul><ul><li>- OVID, PubMed, Embase, Cochrane, Web of Science.  </li></ul></...
Results <ul><ul><ul><li>Lightning injury does not occur frequently, but when it  </li></ul></ul></ul><ul><ul><ul><li>occur...
Limitations <ul><li>Small sample sizes. </li></ul><ul><li>Limited generalizability (external validity).  </li></ul><ul><li...
Nursing Management <ul><ul><ul><li>Encourage the client to seek medical attention immediately after the injury. </li></ul>...
Nursing Management continued <ul><ul><ul><li>Teach positive problem focused coping mechanisms.  </li></ul></ul></ul><ul><u...
End of Presentation <ul><li>ANY QUESTIONS? </li></ul>
References <ul><ul><ul><li>Anson, K.A., & Ponsford, J. (2006).   Coping and emotional  adjustment following traumatic brai...
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Comparison: Lightning Injury, Electrical Injury

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Undergraduate research presentation comparing lighting and electrical injury

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Comparison: Lightning Injury, Electrical Injury

  1. 1. Nursing management for lightning or electrically injured patient
  2. 2. Introduction: Lightning and Electrical Injuries <ul><li>The Purpose of this Presentation is to: </li></ul><ul><ul><li>Learn about lightning and electrical injury. </li></ul></ul><ul><ul><li>Learn about cultural impact of lightning injury. </li></ul></ul><ul><ul><li>Learn about myths of lightning injury. </li></ul></ul><ul><ul><li>Explore purpose of student research project. </li></ul></ul><ul><ul><li>Explore research methods of project. </li></ul></ul><ul><ul><li>Explore results of project. </li></ul></ul><ul><ul><li>Explore limitations of project. </li></ul></ul><ul><ul><li>Explore nursing implications of project. </li></ul></ul>
  3. 3. Lightning Injury <ul><li>Background: </li></ul><ul><li>Odds of being struck: 1 out of 5,000 in lifetime. </li></ul><ul><li>2 nd LARGEST storm killer in US. </li></ul><ul><li>About 10% of people die each year from lightning injury (asystole). </li></ul><ul><li>US population at most risk: </li></ul><ul><li>Construction workers. </li></ul><ul><li>Agriculture workers. </li></ul><ul><li>Outdoor Recreationers. </li></ul><ul><li>Children (playing outdoors). </li></ul><ul><li>Global population at greatest risk (highest lightning frequency): </li></ul><ul><li>Low-technology, agriculture workers in tropical & subtropical areas. </li></ul><ul><li>Thailand, Singapore, Kenya, and South Africa. </li></ul>
  4. 4. Lightning Injury <ul><li>Cultural Consideration: </li></ul><ul><ul><ul><li>South Africa: Death by lightning is seen as a family curse. </li></ul></ul></ul><ul><ul><ul><li>Peru: Person injured person by lightning, community assumes the person and person’s family are damned by God, so that the family is ostracized from the community. </li></ul></ul></ul><ul><ul><ul><li>Ancient Rome : Person killed by lightning, the Roman citizen is denied burial because community views the person as cursed. </li></ul></ul></ul><ul><ul><ul><li>Ancient Greece : Lightning favored by the gods because ancient god Zeus was the god of the sky and the lightning bolt was his natural element of choice. </li></ul></ul></ul>
  5. 5. Lightning Injury <ul><li>Common Myths </li></ul><ul><ul><li>All people who suffer lightning injury are by direct strike. ONLY 3% TO 5% OF INJURIES ARE FROM DIRECT STRIKES! </li></ul></ul><ul><ul><ul><li>1/3 = side-flash : person was close to a tall object (i.e. tree) and the bolt hit the tree, the flash from the bolt traveled to the person. </li></ul></ul></ul><ul><ul><ul><li>1/3 = caused by ground current : bolt hit ground and radiates (picture in next slide). </li></ul></ul></ul><ul><ul><ul><li>1/3 = person using electrical equipment while indoors . </li></ul></ul></ul>
  6. 6. Lightning Injury <ul><li>Figure: Dead cows lined up along a metallic fence. Lightning struck the fence, and the current traveled along the fence killing the cows. Photo Courtesy Ruth Lyon-Bateman (NOAA: National Weather Service Lightning Safety, 2007). </li></ul>
  7. 7. Lightning Injury <ul><li>Common Myths continued...: </li></ul><ul><ul><ul><li>Lightning never strikes the same client twice. </li></ul></ul></ul><ul><ul><ul><li>A lightning victim is electrified; if you touch them you’ll be electrified. </li></ul></ul></ul><ul><ul><ul><li>Burns are the primary healthcare concern after lightning strike. </li></ul></ul></ul><ul><ul><ul><li>Tires on a car or rubber soles on shoes keeps the person safe from a lightning strike. </li></ul></ul></ul><ul><ul><ul><li>If it is not raining, or if clouds are not in sight; I’m safe from lightning (Top 10 Myths of Lightning Safety) . </li></ul></ul></ul>
  8. 8. Lightning Injury <ul><li>How Lightning Injury Impacts the Patient: </li></ul><ul><li>About 90% of people are injured each year from lightning injury survive with a range of disabilities. </li></ul><ul><li>COGNITION and BEHAVIOUR are one of the primary concerns. </li></ul><ul><li>Cognitive/behavioural effects are irreversible : </li></ul><ul><ul><li>Anterograde amnesia: cannot recall events that occurred after onset of lightning strike. </li></ul></ul><ul><ul><li>Poor short term memory. </li></ul></ul><ul><ul><li>Poor input organization, access and coding of information. </li></ul></ul><ul><ul><li>Insomnia. </li></ul></ul><ul><ul><li>Depression. </li></ul></ul><ul><ul><li>Personality change (increased irritability) frontal lobe damage. </li></ul></ul>
  9. 9. Lightning Safety <ul><li>“The principle lightning safety guide is the 30-30 rule. The first “30” represents 30 seconds. If the time between when you see the flash and hear the thunder is 30 seconds or less, the lightning is close enough to hit you. If you have not already, seek shelter immediately. The second “30” stands for 30 minutes. After the last flash of lightning, wait 30 minutes before leaving your shelter ” (NOAA: National Weather Service, 2007) . </li></ul>
  10. 10. Electrical Injury <ul><li>Account for 1,000 fatalities per year. </li></ul><ul><li>BURNS are one of the primary concerns. </li></ul><ul><li>Typical injury manifest as deep-partial to full-thickness burns. </li></ul><ul><ul><li>Responsible for approximately 6.5% of all admissions to burn units in the US. </li></ul></ul><ul><ul><li>Can be Direct Current (D/C) or Alternating Current (A/C). </li></ul></ul><ul><ul><li>D/C = low voltage (<500 volts) muscle spasm, often throwing the person away from the source. </li></ul></ul><ul><ul><li>A/C = high voltage (>1000volts) muscle contraction (tetany) occurs and the person cannot release from the source. </li></ul></ul><ul><li>US population at most risk: </li></ul><ul><ul><li>Electrical workers. </li></ul></ul><ul><ul><li>Small children. </li></ul></ul>
  11. 11. Lightning vs Electrical Summary of the Two Insults Secondary blunt trauma can be seen if the person is thrown from the electrical source. Difference of Lightning and Industrial Electricity Credit: www.elsevier.com/locate/burns
  12. 12. Pictures Lightning Injury Burn Superficial burns, note linear patten Photo credit: www.osha.gov Electrical Injury Burn Full-thickness burn, note hole into back Photo credit: www.sagepublications.com
  13. 13. Purpose and Research Question <ul><ul><li> To explore the nursing management in current practice that address the long-term, chronic effects of adults suffering from sequelae of lightning or electrical injury. </li></ul></ul><ul><ul><li> What are the most effective nursing interventions to manage neurologic and psychiatric, long-term sequelae suffered by adults following electrical or lightning injury? </li></ul></ul>
  14. 14. Methods <ul><ul><li>Databases: </li></ul></ul><ul><ul><li>- OVID, PubMed, Embase, Cochrane, Web of Science. </li></ul></ul><ul><ul><li>Search terms: “Lightning Injury”, Electrical Injury”, “Brain Injury”. </li></ul></ul><ul><ul><li>Time limits: 1996 to 2007. </li></ul></ul><ul><ul><li>Article Selection and Results: </li></ul></ul><ul><ul><li>long term management strategies. </li></ul></ul><ul><ul><li>cognitive dysfunctions and behavioral changes. </li></ul></ul><ul><ul><li>knowledge deficit of nursing care. </li></ul></ul><ul><ul><li>quality of life. </li></ul></ul>
  15. 15. Results <ul><ul><ul><li>Lightning injury does not occur frequently, but when it </li></ul></ul></ul><ul><ul><ul><li>occurs, it immensely impacts the patient and the family. </li></ul></ul></ul><ul><ul><ul><li>When a person is struck by lightning, often, the client does </li></ul></ul></ul><ul><ul><ul><li>not go the Emergency Department immediately after injury. </li></ul></ul></ul><ul><ul><ul><li>Most clients do not understand the neurocognitive deficits </li></ul></ul></ul><ul><ul><ul><li>of lightning injury. Many of the deficits are similar to ones </li></ul></ul></ul><ul><ul><ul><li>observed in traumatic brain injury. Based on the </li></ul></ul></ul><ul><ul><ul><li>investigators literary research, nursing students have more </li></ul></ul></ul><ul><ul><ul><li>access to current literary resources which focus on electrical </li></ul></ul></ul><ul><ul><ul><li>injury than lightning injury. </li></ul></ul></ul>
  16. 16. Limitations <ul><li>Small sample sizes. </li></ul><ul><li>Limited generalizability (external validity). </li></ul><ul><li>Low response rates. </li></ul><ul><li>Missing documentation. </li></ul>
  17. 17. Nursing Management <ul><ul><ul><li>Encourage the client to seek medical attention immediately after the injury. </li></ul></ul></ul><ul><ul><ul><li>Assess levels of pain; assist with pain medication regimen. </li></ul></ul></ul><ul><ul><ul><li>Use active listening skills to establish a therapeutic relationship with the client. </li></ul></ul></ul><ul><ul><ul><li>Assess cognitive function and memory. Re-orient as needed. </li></ul></ul></ul><ul><ul><ul><li>Help the family create a book with family and friends photos. </li></ul></ul></ul><ul><ul><ul><li>Assist with developing a routine of daily activities for home. </li></ul></ul></ul><ul><ul><ul><li>Assess for signs of psychiatric depression. </li></ul></ul></ul>
  18. 18. Nursing Management continued <ul><ul><ul><li>Teach positive problem focused coping mechanisms. </li></ul></ul></ul><ul><ul><ul><li>Refer the client to peer support groups. </li></ul></ul></ul><ul><ul><ul><li>Assess the cultural beliefs and values of the client and family. </li></ul></ul></ul><ul><ul><ul><li>Cultural perception of lightning injury differ in each culture and this influences the supportive care for the patient. </li></ul></ul></ul><ul><ul><ul><li>Suggest using a calendar or organizer for daily activities. </li></ul></ul></ul><ul><ul><ul><li>Use empathetic communication; encourage the client and family to express emotions. </li></ul></ul></ul><ul><ul><ul><li>Discuss community resources with the client and family. </li></ul></ul></ul><ul><ul><ul><li>Encourage client to maintain the highest level of functioning. </li></ul></ul></ul>
  19. 19. End of Presentation <ul><li>ANY QUESTIONS? </li></ul>
  20. 20. References <ul><ul><ul><li>Anson, K.A., & Ponsford, J. (2006). Coping and emotional adjustment following traumatic brain injury. [Electronic Version]. Journal of Head Trauma Rehabilitation , 21, 248-259. </li></ul></ul></ul><ul><ul><ul><li>Cooper, M. A., & Price, T. (2006). Electrical and lightning injuries. [Electronic Version]. Rosen’s Emergency Medicine, Concepts and Clinical Processes. 6 th ed. St. Louis: Elsevier. </li></ul></ul></ul><ul><ul><ul><li>Hendler, N.(2005). Overlooked diagnoses in chronic </li></ul></ul></ul><ul><ul><ul><li>pain: Analysis of survivors of electric shock and lightning strike. [Electronic Version ]. American College of Occupational Environmental Medicine , 47, 796-805. </li></ul></ul></ul><ul><ul><ul><li>Janus, T.J, & Barrash J. (1996). Neurologic and neurobehavioral effects of electric and lightning injuries. [Electronic Version]. Journal of Burn Care & Rehabilitation , 17, 409-415. </li></ul></ul></ul><ul><ul><ul><li>National Oceanic and Atomospheric Administration. (2007). National Weather Service, lightning safety . Retrieved September 15, 2007, from http://www.lightningsafety.noaa.gov/outdoors.htm </li></ul></ul></ul><ul><ul><ul><li>Noble, J., Gomez, M., & Fish, J. (2005). Quality of life and return to work following electrical burns. [Electronic Version]. Burns , 32, 159-164. </li></ul></ul></ul><ul><ul><ul><li>Roeder, M. (2002). Top-10 myths of lightning safety. Struck By Lightning.org . Retrieved September 15, 2007, from www.struckbylightning.org . </li></ul></ul></ul>

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