Clinical case report: application of a combination of advanced techniques in management of a soldier with severe ordnance burns and concomitant inhalation injury

Tóm tắt

Introduction: The combination of extensive burns, inhalation injury and polytrauma represents one of the greatest challenges in emergency and disaster medicine, associated with high mortality rates due to complications such as shock, acute respiratory distress syndrome (ARDS), multiple organ dysfunction and sepsis. We report a clinical case of the successful resuscitation and management of a soldier who sustained 80% total body surface area (TBSA) ordnance burns (including 50% full-thickness burns), complicated by severe inhalation injury and complex polytrauma.
Case Presentation: A 21-year-old male soldier sustained burns and polytrauma from an ordnance-related incident. Following initial resuscitation and aeromedical evacuation to the Le Huu Trac National Burns Hospital, an aggressive, multimodal treatment strategy was implemented. Within the first 48 hours, the patient underwent extensive surgical excision of the burn eschar over 50% of his TBSA. In the subsequent course of treatment, due to unsalvageable crush injuries, the patient required amputation of the distal third of the right lower leg and the distal third of the right arm for source control of infection. Advanced techniques were applied synchronously, including treatment of the inhalation injury with nebulized Heparin and N-Acetylcysteine, invasive hemodynamic monitoring with the PiCCO system, Negative Pressure Wound Therapy (NPWT) and wound coverage using autologous skin grafts combined with a non-cultured autologous cell suspension. After 3 months of treatment and 6 surgical procedures, the patient achieved complete wound coverage. He survived the critical phase, successfully avoiding common high-mortality complications such as acute renal failure, sepsis, multiple organ dysfunction and ARDS and was subsequently transferred to the rehabilitation phase.
Conclusion: The coordinated chain of care-from pre-hospital stabilization for airlift to the synchronized application of advanced technologies at a specialized center-was critical for the patient's survival through the critical phase. This case underscores the decisive role of an aggressive, proactive and technology-driven treatment strategy in improving outcomes for patients with catastrophic burn injuries.