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Case 170: Industrial Accident

This gentleman was brought to ED complaining of pain in the left hand. He recalls being at work near a high pressure air tank and hearing a loud explosion. On examination, he has bleeding from the ears and his L hand is shown.

1. What is the diagnosis and how will you manage him?

Although external soft tissue damage may seem minimal, this man's hand is swollen and is at risk of compartment syndrome. He needs neurovascular examination, imaging for structural damage and urgent plastics review.

2. You order an XR. What is shown?

Comminuted fractures of the 2,3,4 metacarpal bones.

3. What can be done for him in theatre?

GA + bracial plexus block (providing both perioperative and postoperative analgesia of up to 8Hours), fasciotomy, ORIF (K wires).

The bleeding from the ears most likley represents ruptured tympanic membranes - as part of the blast injury. This injury will reqiure external auditory meatus examination, baseline audiometry and follow up by ENT surgeons.

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Case Contributor:
Richard Kai Yuan Cheng, Medical Student, The Austin Hospital, Melbourne, Australia