Differential Diagnosis for Abdominal Injury and Internal Haemorrhage due to Explosive Injury
- Single most likely diagnosis:
- B. Shrapnel (2ry): This is the most likely diagnosis given the context of an explosive injury. Shrapnel injuries are common in such scenarios and can cause significant internal damage, including abdominal injuries and internal hemorrhage, due to the high-velocity fragments penetrating the body.
- Other Likely diagnoses:
- C. Primary (drum, pleura, bowel): Primary blast injuries occur due to the direct effect of blast overpressure on tissue. The "drum" refers to the blast effect on air-filled organs like the ears and lungs, but primary blast injuries can also affect the bowel, leading to abdominal injuries and potential internal hemorrhage.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- K. Burn (smoke, HTN, angina, hyperglycaemia, asthma, COPD, all Quaternary): Although burns might not be the first consideration for abdominal injury and internal hemorrhage, severe burns can lead to systemic effects, including hypovolemia and potential for internal injuries due to the blast. Additionally, smoke inhalation can lead to respiratory distress, which might indirectly affect the management of abdominal injuries.
- Rare diagnoses:
- Tertiary injuries: These occur when the individual is thrown by the blast and suffers injuries from the subsequent collision with objects or the ground. While less directly related to the primary effects of the blast, tertiary injuries could potentially cause abdominal trauma and internal hemorrhage, especially if the individual is thrown against a hard surface or object.
Each of these diagnoses is considered based on the mechanism of injury (explosive injury) and the presentation (abdominal injury and internal hemorrhage). The likelihood of each diagnosis is influenced by the common patterns of injury seen in blast trauma, with shrapnel injuries being particularly prevalent and dangerous due to their potential for causing deep penetrating trauma.