Chauke Risenga Frank, Sekgololo Joseph Motshedi
Sefako Makgatho Health Sciences University, Postnet Suite 022, Private Bag X1007, Lyttelton 0140, South Africa.
Sefako Makgatho Health Sciences University, Postnet Suite 022, Private Bag X1007, Lyttelton 0140, South Africa.
Int J Surg Case Rep. 2025 Jan;126:110793. doi: 10.1016/j.ijscr.2024.110793. Epub 2024 Dec 27.
Domestic blast chest injuries are because of suicide and accidents. Explosion injuries (trauma) are common in conflicts or military settings. Terrorists attacks result in injuries among the civilian population. A case of a 52-year-old African man who had an oxygen canister/grinder explode on him whilst working with it is reported. This case confirms that the mortality rate of patients with chest blast injuries who reach the hospital is low at less than 5 %.
A 52-year-old man suffered a blast injury from an exploded oxygen canister in July 2018. The shrapnel entered his chest, shattering his ribs and causing lung lacerations. He underwent urgent thoracotomy to remove the foreign body and chest wall reconstruction. Complications included clotted haemothorax and rhabdomyolysis, leading to acute kidney injury, and requiring dialysis. He was discharged after seven weeks.
Thoracic blast injuries can occur at various subcellular levels. Management involves primary and secondary surveys, followed by patient disposition. Unstable patients require immediate definitive and/or damage control treatment, while stable patients benefit from radiological investigations (chest X-ray, E-FAST, CT-scan) and physiological studies (blood gas analysis, full blood count (FBC), urea, electrolytes and creatinine (UEC) analysis, cardiac markers, and clotting profile evaluation. Definitive management is tailored to the injury's severity and location. Blast injuries are classified into four categories: primary, secondary, tertiary, and quaternary. Our patient had secondary and quaternary injuries. The management depends on patient stability.
Effective management protocols are essential to improve survival rates in blast-related chest trauma.
国内的胸部爆炸伤多由自杀和事故所致。爆炸伤（创伤）在冲突或军事环境中很常见。恐怖袭击会导致平民受伤。本文报告了一例52岁非洲男性的病例，该男子在使用氧气罐/研磨机时氧气罐发生爆炸。该病例证实，送达医院的胸部爆炸伤患者死亡率较低，低于5%。
一名52岁男性在2018年7月因氧气罐爆炸而遭受爆炸伤。弹片进入其胸部，肋骨骨折并导致肺撕裂。他接受了紧急开胸手术以取出异物并进行胸壁重建。并发症包括血凝性血胸和横纹肌溶解，进而导致急性肾损伤，需要进行透析。七周后他出院了。
胸部爆炸伤可发生在不同的亚细胞水平。治疗包括初级和次级评估，然后是患者处置。不稳定的患者需要立即进行确定性和/或损伤控制治疗，而稳定的患者则受益于放射学检查（胸部X光、急诊快速超声心动图、CT扫描）和生理学研究（血气分析、全血细胞计数、尿素、电解质和肌酐分析、心脏标志物以及凝血指标评估）。确定性治疗是根据损伤的严重程度和部位量身定制的。爆炸伤分为四类：原发性、继发性、三次性和四次性。我们这位患者有继发性和四次性损伤。治疗取决于患者的稳定性。
有效的治疗方案对于提高爆炸相关胸部创伤的生存率至关重要。
