Multiple mechanical and thermal blast injury in civilian industrial setting - possible parallel to the battlefield blast syndrome type injuries
Abstract
A 43-year-old man, injured during a factory explosion on January 4, 2010, was transported to the nearest hospital. Volume resuscitation started, subclavian vein cannulation, chest tube, and covering of burns were performed.
The intubated and ventilated patient was transferred by helicopter to our hospital. The leading diagnoses were: haemorrhagic - traumatic and burns schock, haemoperitoneum, pneumothorax, subtotal amputation of the left distal crus/feet, burns over 40% of the body surface, right calcaneus fracture etc.
Preliminary circulatory stabilisation with discontinuation of neorepinephrine infusion was achieved within 10 hours, by excessive positive fluid balance, which took three days (22, 10 and 9 litres). Prelimnary blood lactate 7 mmol/l was normalised within 24 hours.
Blood albumin level 15 g/l was tolerated without any artificial replacement. The second hit appeared on day 10, in a form of septic shock caused by Aspergillus fumigatus infection from the lacerated left lower limb.
High-volume continuous haemodiafiltration because of hyperpyrexia was use, after the exarticulation in the left knee-joint. An excessive proteolysis (urea loss more than 1000 mmol/day) persisted 1,5 months, with energy expenditure over 2600 kcal/day.
The patient underwent multiple surgical interventions. Metabolic support using combined parenteral and enteral nutrition was performed during the first month, enteral nutrition combined with food were consequently given form more than 3 months.
The pacient was hospitalised until April 26, 2010. These types of traumas are fully comparable with military battlefield invironment injuries.
Principles of war surgery (life and limb savint, damage control surgery) should be applied also in civilian environment, particularly in disaster situations.