Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Hospitalito Atitlan 5

Towards the end of my week at the Hospitalito, one of the staff members asked me to speak with the parents of a teenager who had suffered an electrical injury in the past few days. The young boy had climbed onto a roof in pursuit of a kicked soccer ball. The young man was sweating, and he recalled wearing a wet tee-shirt. The ball had come to rest near the business end of a power-supplying transformer. The boy’s head came sufficiently close to the transformer to cause it to discharge an arc directly onto the top of his head. The youth was rendered immediately unconscious and thrown by the force of the current. He remembered climbing up onto the roof and waking up in an ambulance, but nothing in between. The errant power discharge tripped the breakers, or he might have been killed.

Although it was his misfortune to have been struck by the electricity, he was incredibly lucky with respect to his landing spot. The perimeter of the roof was ringed by a raised concrete edge with embedded chunks of sharp glass, placed to deter intruders. There were only a few small sections of the edge without glass, and he landed face down in one of them, or he might have been impaled and shredded. His friends called for help and he was rushed to emergency care, from where he was transferred to a hospital. According to his parents’ report, he was managed very well, as the doctors considered injuries to his brain, bones and muscles, kidneys, and heart. Again, luck prevailed, as his only serious injuries appeared to be burns.

The burn pattern was a hybrid between what one would expect to see with a lightning strike and an industrial injury. That is, the electricity entered via the top of his head, appeared to flash over his body, and exited via his legs. He suffered first and second degree burns on his scalp, across his chest, and down the front and back of his legs. The current followed what was probably the pattern of superficial moisture on his body. However, they did not have the typical “ferning” or “punctuate (flower-like)” configuration of a lightning strike, but appeared more like scald burns. So, he suffered a “flashover phenomenon,” but with a lesser voltage than would have been incurred by a lightning strike. He also did not suffer other common sequelae of a lightning strike, such as ruptured eardrums, visual changes, or significant amnesia.

I examined this very nice young man a few days after he left the hospital. The burns on his body were doing nicely, except for some deeper second degree burns on the backs of his legs. These needed to be treated more aggressively with topical moisturizing cream to decrease dessication and increase pliability, and to allow the initiation of physical therapy (gradual stretching) to prevent his muscles from forming contractures. Both the youth and his father were very gracious, and gave me permission to take photographs for the purposes of this description and teaching. In a few weeks, I fully expect his soccer career to resume.

Preview the 25th Anniversary & Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 25-30, 2008.

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.