I was going to write about the worst July 4th accident I had seen in the ED prior to July 4, but I got bogged down in other things and then had to take an unexpected road trip out of state.
The story is below. If you’re wondering why I’m telling the story after July 4th, continue reading. There was a contender for the worst injury that was seen for a follow up visit yesterday.
The first patient was a man in his early twenties I saw many years ago. Still remember his case very well.
He was riding around as a passenger in a car after July 4th with some friends when he saw someone that he knew who was driving a car up ahead of him. He had some leftover fireworks, so he pulled out an M-80, and, as they got closer to the acquaintance’s car, he rolled down the window and lit the M-80, intending to throw it on the hood of the acquaintance’s car. When he reached out the window to throw the M-80, the lit M-80 hit the edge of the window and dropped into the patient’s lap. The patient quickly grabbed the M-80 and tried to throw it out the window, but the M-80 blew up in his hand before he released it. The window shattered, cutting his face in several places.
The patient’s right hand was a mess. The skin and tissues were completely gone from the last joints of his thumb, index, and middle fingers. All that remained was bones and the frayed edges of skin and tendons. His ring and fifth fingers still had the skin attached, but were broken and twisted outward. Four metacarpals in his hand were broken from the blast. He was in horrible pain. We gave him several doses of IV pain medication, but they didn’t help. The only way I could get him out of pain was to perform nerve blocks on his hand.
He had been drinking, so once he was out of pain, he kept looking at his hand and saying how “cool” it was. I could remember the patient’s mother sitting on the side of the bed just sobbing. The hand surgeon said that several of his fingers would need to be partially amputated, but I never saw the patient after his initial ED visit.
That was the worst. Probably still is the worst. Then there’s the one below.
Yesterday was a follow up visit from a patient who was firing off mortars in his friend’s back yard – in another state. He didn’t want to go back to the other state for a follow up appointment and wanted a surgeon nearby to provide his follow up care.
The patient put a mortar in the tube and lit the fuse. Then he saw that the mortar wasn’t all the way down the tube, so he used his fingers to quickly push the mortar the rest of the way down the tube. Unfortunately, the fuse was “the fastest burning fuse he had ever seen.” The mortar went off and exploded into his wrist and hand. From his description, the tips of his four fingers were gone. His wrist was broken in several places. Bones in his hand were dislocated. There was a large bloody blast wound to the flexor surface of his forearm. Many tendons were ripped apart. There was tattooing of soot with ulcerations most of the way up his inner arm. His hand and wrist were splinted with what appeared to be a Kleinert splint and Kirchner wires were sticking out of several places in his hand. His fingers had good capillary refill and that was all that was being checked during his visit.
Needless to say, our local orthopedist didn’t feel comfortable accepting care for the patient. So the patient got a bill for his visit and he still had to follow up with the out of state hand surgeon.
Don’t know if there is a moral to this story. All fireworks are dangerous. Even sparklers burn at extremely high temperatures.
Just be careful out there.
And be extra nice to the hand surgeons when you work in the EDs during the first week of July.
