Blasted

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.

Select Relevant Investigations
Full blood count

Performed

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

Performed

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

Performed

The FAST scan was negative for internal bleeding
X-ray pelvis

Performed

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.

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