Ryan Blumenthal

Erratum to: The individualisation of a dog bite mark: a case study highlighting the bite mark analysis, with emphasis on differences between dog and human bite marks

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Does a Sixth Mechanism Exist to Explain Lightning Injuries?: Investigating a Possible New Injury Mechanism to Determine the Cause of Injuries Related to Close Lightning Flashes

AbstractFive mechanisms have been described in the literature regarding lightning injury mechanisms. A sixth mechanism is proposed in this article, namely, lightning barotrauma. A simple laboratory experiment was conducted using ordnance gelatin for ballistic studies. Lightning was simulated in a high-voltage laboratory using an 8/20-microsecond current impulse generator and discharged through ballistic gel. Temporary and permanent cavity formations were confirmed. The cavities formed were directly proportional to the currents used. Findings suggest that a sixth mechanism of lightning injury, namely, barotrauma, should be considered.

Lightning medicine in South Africa

South Africa has a rich history of lightning research; however, research on the clinical and pathological effects and features of lightning-related injury (keraunomedicine or lightning medicine) remains neglected locally. By providing an overview of keraunomedicine and focussing on South African perspectives, we hope to raise awareness and propose that a concerted and co-ordinated attempt be made to report and collate data regarding lightning strike victims in South Africa.

Secondary Missile Injury From Lightning Strike

AbstractA 48-year-old-woman was struck dead by lightning on October 24, 2010, in Pretoria, South Africa. The cause of death was due to direct lightning strike. Examination showed secondary missile injury on her legs. This secondary missile (shrapnel) injury was caused by the lightning striking the concrete pavement next to her. Small pieces of concrete were located embedded within the shrapnel wounds. This case report represents the first documented case of secondary missile formation (shrapnel injury) due to lightning strike in the literature.

The Explosive Effects of Lightning: What are the Risks?

The explosive effects of lightning have been known to exist for some time; however the precise risks associated with it have been generally unknown. This curious injury phenomenon has existed historically under many different names in the literature: “lightnings pressure blast wave,” “arc blast,” “shattering effects of lightning,” “pressures developed by arcs,” “thunder generation of shock waves,” and “the sixth mechanism of lightning injury” are but a few of the many divergent and disparate terminologies used in the past to describe this invisible blast phenomenon. Blunt force trauma injuries and barotrauma injuries are often identified on lightning strike victims. Lightnings pressure blast wave and its associated overpressure does appear to have significant injury implications associated with it. This paper takes an in-depth look at the explosive effects of lightning and the main blast-related pathologies seen on lightning strike victims. Knowledge and insight into this phenomenon may help forensic pathologists and those working in the fields of lightning injury and lightning protection. A general literature search of the medical, the electrical engineering, and the mechanical engineering literature was conducted. By looking exclusively at the pathology of barotrauma in the human body, forensic pathologists may now get a relatively good idea as to the possible overpressures and distances involved with regards to lightnings explosive effects.

Bone marrow embolism to the lung in electrocution : two case reports

Bone marrow embolism in electrocution was first described in the literature by Rappaport et al (Am J Pathol. 1951;27(3):407-433) in 1951. Two case studies demonstrating this phenomenon are reported here, one involving high-voltage exposure with associated skeletal injuries and the other involving domestic current and without evidence of skeletal injury. Both cases demonstrated bone marrow embolism on histologic examination of the lungs. The purposes of this article are to reiterate the existence of this unusual phenomenon and to consider possible pathogenetic mechanisms.

A Fire Extinguisher Death: The Macklin Effect

We present the case of an adult white man found dead in a psychiatric institution with fine white powder (monoammonium phosphate) deposited over the entire face after he insufflated the contents of a dry chemical fire extinguisher. Fine white powder was present within the mouth and sinuses and lined the upper airways. On opening the thoracic cavity, approximately 500 g of fine white powder was present within the right thoracic cavity. The esophagus was ruptured. Traumatic emphysema of the posterior sternum wall was present (pneumomediastinum). The ethmoid bones were fractured by the barotrauma. On polarization of the lung tissue, birefringent material was noted deposited along the bronchovascular sheaths and in a subpleural distribution. Death was probably due to a combination of barotrauma and asphyxia.This case study provides strong evidence in support of the etiology and pathophysiology of the Macklin effect. It also provides for the first visual evidence of the phenomenon.

Case report : lightning-induced pneumomediastinum

Abstract We present the case of a 41-year-old woman who was fatally injured during a witnessed lightning strike event and in whom autopsy revealed the unusual keraunopathological finding of overt pneumomediastinum. The possible pathophysiological mechanism(s) of causation of this phenomenon are discussed, with specific reference also to the “Macklin” effect and the role of blast overpressures associated with lightning strike. It is suggested that the latter may lead to sudden alveolar rupture, with subsequent rapid tracking of air along bronchovascular sheaths in a centripetal manner toward the hilum of the lung and thus into the mediastinum. A review of the blast literature suggests that this victim would have been exposed to a blast pressure wave of approximately 29-psi (200 kPa) to 72-psi (500 kPa) magnitude.

A follow-up study of a large group of children struck by lightning

We report on the largest case to date of children with significant injuries from a single lightning strike. A retrospective analysis was done of the camping scene and injuries to 28 people (26 preadolescent girls and 2 adult supervisors) and 7 dogs from a documented lightning strike. Of the 35 victims sleeping in the tent, 4 girls and 4 dogs were fatally injured. The 2 adults were unharmed, but 23 of the children suffered injuries including burns (23), cataracts (8), macular holes (4), tympanic membrane rupture (2), and skull fracture (2). Many of these injuries occurred more frequently than would be expected from prior large reviews and reports.

Lightning medicine in rural practice

Key points to remember in rural practice when investigating lightning incidents is to try and get as much data as possible. Visit the scene if possible. Consult experts from other disciplines (such as electrical engineers) and try to obtain as much collateral information as possible. Even try and confirm the precise time and pinpoint location of the ‘culprit’ lightning strike with your local weather service (yes, this is possible!)