Which complication should be checked for in lightning injuries during the work-up?

• A. Rhabdomyolysis
• B. Pulmonary Embolism
• C. Pneumothorax
• D. Stroke

Answer: (A)

Rhabdomyolysis is the key complication to check for after a lightning injury because the intense muscle contractions and energy surge can cause widespread muscle cell breakdown. This releases myoglobin and intracellular potassium into the bloodstream, which can rapidly lead to acute kidney injury and dangerous electrolyte disturbances.

In practice, work-up should include checking creatine kinase (often greatly elevated), assessing kidney function (BUN/creatinine), and looking for myoglobinuria (dark or red-brown urine). Aggressive IV fluid rehydration is essential to protect the kidneys, with monitoring of urine output and electrolytes to detect and treat hyperkalemia or other shifts.

Other potential problems can occur, but they are not as central to the immediate work-up as rhabdomyolysis.