Blast Injury

Blasted

Step 1: View clinicals

A 32-year-old man presents with multiple traumatic injuries sustained when a bomb exploded at a public event. At the scene, he had a complete amputation of his right leg below the patella, with copious blood loss. A tourniquet was applied to the right upper leg. He was then immobilized and transported to the hospital by ambulance, arriving 29 minutes after the explosion. No additional history is known.


Step 2: Order all relevant investigations

Full blood count

WBC/DC: 7,000/mm3 Hb: 9.5 g/dL Hct: 30% (low) Plt: 230,000/mm3 (normal)

Clotting studies

PT: 12.7s (11-14) INR: 1.0 (0.8-1.2) aPTT: 29.7s (25-35)

FAST scan

The FAST scan was negative for internal bleeding

X-ray pelvis

X-rays of the pelvis show no pelvic fractures. However, there are multiple metallic foreign bodies in the pelvis that appear to be small nails and ball bearings.


Step 3: Select appropriate management

Apply a second tourniquet
Blood transfusion
Exploratory laparotomy
Above-knee amputation


Score: ★★☆