What's Your Diagnosis? Blast Injuries

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got last month’s case on An Evidence-Based Approach to Emergency Department Patients at Risk for Posttraumatic Stress Disorder Symptoms correct.

Case Presentation: Diagnosis and Management of Blast Injuries in the Emergency Department

EMS and local police issue a notification that an explosion has occurred at an elementary school. Within an hour, the first patient arrives: a 29-year-old woman with torso and extremity lacerations…

The patient arrives by personal vehicle.
She has no other complaints and no medical history. Her vital signs are: heart rate, 110 beats/min; blood pressure, 110/80 mm Hg; and oxygen saturation, 97% on room air.
You give her medication for pain control and a tetanus booster, and repair her extremity lacerations.
On re-evaluation, she says she feels better, though you wonder whether it is safe to discharge her or if there might be delayed sequelae of the blast that need to be watched for…

Case Conclusion

This patient had sustained a secondary blast injury, and you also had concern for possible primary blast injury, as she was unure how far she was from the initial blast. On re-evaluation, she said felt better after pain medication, but did still have some residual discomfort in her abdomen. You offered the patient further observation; however, she stated that she wanted to leave and go home to check on her family and students, so you discharged her with strict return precautions to return immediately for any worsening pain. The patient re-presented 6 hours later with abdominal pain, and she was found to be hypotensive, with a perforated bowel. She was admitted to the ICU with trauma surgery.