Journal of Trauma and Injury

Case Reports

Inhalation injury after a landmine explosion: a case report: Woojung Kim, Donghoon Kim, Sung Yub Jeong, Yoonhyun Lee, Hojun Lee; J Trauma Inj. 2022;35(Suppl 1):S35-S39. Published online June 23, 2022; DOI: https://doi.org/10.20408/jti.2022.0005

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Abstract PDF: Blast injuries are divided into four classes, and inhalation injuries are a quaternary class of blast injuries. An inhalation injury can be critical to the patient due to the possibility of related complications, such as airway obstruction resulting from upper airway edema and pneumonia. Once diagnosed, an inhalation injury should be treated with early intubation, aerosol therapy, and antibiotics as soon as possible. We should suspect this injury in circumstances involving fire and especially bomb attacks in a military setting. Antipersonnel landmines designed to damage the soldier by amputating the leg can cause blast injuries, but their power is limited to the lower extremity. However, we found an inhalation injury in a victim whose leg had been amputated by an antipersonnel landmine. As soon as we suspected an inhalation injury, we intubated the patient to preserve his airway and started acetylcysteine/heparin aerosol therapy. The patient also was treated with proper antibiotics for right lower lung pneumonia that developed as a sequela of inhalation injury. We could extubate the patient without any complications such as airway obstruction on the third day of intensive care, after which the patient was transferred to the general ward for active rehabilitation. This report presents the first known case of inhalation injury due to a landmine explosion.; Summary

Acute methemoglobinemia after a blast injury: a case report: Donghoon Kim, Yoonhyun Lee, Sung Yub Jeong, Hojun Lee; J Trauma Inj. 2022;35(Suppl 1):S15-S17. Published online December 10, 2021; DOI: https://doi.org/10.20408/jti.2021.0089

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Methemoglobin is a structurally modified form of hemoglobin incapable of binding oxygen, and elevated levels of methemoglobin cause tissue hypoxia. Occupational exposure to 2,4,6-trinitrotoluene, commonly called trinitrotoluene, causes methemoglobinemia. This case report describes a 27-year-old male sergeant who developed methemoglobinemia upon exposure to trinitrotoluene after a blast injury while welding the walls of tank shells. This is the first case of its kind in Korea. The patient had multiple burns in his abdomen and open fractures in his right leg. While his body temperature, heart rate, respiratory rate, arterial blood pressure, and chest X-ray were normal, arterial gas analysis revealed acute (methemoglobinemia concentration, 13.5%; oxygen saturation, 92.0%), probably caused by nitroglycerin exposure. Aspiration and adsorption through the skin and respiratory system were suspected to be the routes of entry. His methemoglobinemia normalized after 4 days after treating the wounds surgically, administering oxygen therapy, and performing blood transfusion.

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Citations

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Methemoglobinemia screening and treatment in tank warfare survivors: A case series
Shahar Negev, Shaun Gruenbaum, Amit Frenkel, Alexander Zlotnik, Ohad Gabay
The American Journal of Emergency Medicine.2024;[Epub] CrossRef

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