Blasted

Musculoskeletal System


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 Relevant Investigations

1. Full blood count

check

WBC/DC: 7,000/mm3

Hb: 9.5 g/dL

Hct: 30% (low)

Plt: 230,000/mm3 (normal)

2. Clotting studies

check

PT: 12.7s (11-14)

INR: 1.0 (0.8-1.2)

aPTT: 29.7s (25-35)

3. FAST scan

check

The FAST scan was negative for internal bleeding

4. X-ray pelvis

clear

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

1. Apply a second tourniquet

check

2. Blood transfusion

check

3. Exploratory laparotomy

clear

4. Above-knee amputation

check