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Bomb Blast
HB,
Good case.
I would be thinking along the lines of,
1) Primary blast injury (Compressed shockwave damage) - bowel, lungs, ears and brain. Since this was outside the shock wave of compressed air would have dissipated.
2) Secondary blast injury (Shrapnel) - penetrating shrapnel gets everything including extremities, torso and head/neck
3) Tertiary blast injury (Patient being thrown back inches, feet, yards) depending on how the patient lands will mean injuries to that area, so think about spine, head and long bone injuries
4) Quaternary ( Miscellaneous) This is a trash can area of diagnoses like burns, asthma/COPD exacerbation from dust, chemical injuries, MI's, etc. Really represents those injuries not cause by the first three. Oh, think about crush injuries, too.
Some have started talking about quininary injures as well but I will investigate that for the site.
Start with the ABC's but if in the military and in the field with life-threatening hemorrhage from an extremity start with "C" then AB. Use a tourniquet. It may be that the limb will die, but the life will be saved. So, it is life or limb . . . always. Reassess "C" once again before going on to D and E.
Good job on saving him. I have seen presentations of those injured by suicide bombers in Israel and what bomb victims look like after presenting from those bombings. The injuries can be horrendous and more like, "Where do I start?" Start at the beginning, of course. This is where one's training kicks in . . . The fact that you saved this child's life lends major kudos to you as the first responder and the physicians caring for him after you rescued him.
Sincerely,
Dutch Matthews, MD
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