Lightning on the Pitch: Mass Casualty Triage Reversal
Lightning on the Pitch: Mass Casualty Triage Reversal - Forensic Medicine clinical simulation case. Seventeen-year-old male struck by lightning during a...
Age: 17 • Gender: Male • Setting: Emergency Triage
Clinical Presentation & History
Seventeen-year-old male struck by lightning during a late-afternoon match on an open grass pitch. Witnessed thunder clap, immediate collapse, brief tonic-clonic activity, then unresponsiveness with shallow breathing. Brought in by paramedic ambulance to the ED resuscitation bay. Multiple co-victims en route from the same pitch.
Acute Resuscitation Milestones & Priorities
Clinical phases and key interventions encountered in this emergency module:
Reverse triage in lightning mass casualty: the silent, apneic patient is the highest priority because respiratory arrest outlasts cardiac arrest.
Lichtenberg ferning is pathognomonic of lightning strike and fades within hours — photograph immediately with a ruler scale.
Bilateral tympanic membrane rupture is the most common lightning injury and strongly supports the diagnosis over industrial electrocution.
QTc prolongation and delayed torsades can occur 12–48 hours post-strike; telemetry observation is mandatory.
Preserve all clothing in paper bags (not plastic) for forensic chain of custody; metal objects may be magnetized, synthetic fabric may be vaporized.
Keraunoparalysis causes transient limb weakness from autonomic stunning and resolves over hours — counsel families accordingly.
Test Your Clinical Reasoning in Real Time
Step into the active clinician role for this case. Order diagnostic tests, analyze live laboratory panels, and navigate branching clinical decisions with real-time feedback.