Blast Injuries Case 1

You are working in the ED during a major incident.

There has been an explosion during an open-air concert and multiple casualties have been brought to the department. You have been assigned to 'minors'.

A 30-year-old man with no medical problems self-presents to the ED. He says that he was a member of the audience and was "some distance" from the centre of the explosion.

He is walking and talking and tells you that he heard but did not feel the explosion. He had some ringing in his ears but this has resolved and he can hear normally. He self-presented because he thought he should be "checked over"…

Can this patient be reassured and discharged from the ED or not, and why?

On examination the patient's observations are as follows:

• Pulse: 84, regular
• BP: 116/72
• SpO₂: 97% on air
• RR: 12
• Temp: 36.8^oC

Examination of the cardiovascular system reveals warm peripheries and normal heart sounds. Chest examination reveals normal and equal percussion note with vesicular breath sounds bilaterally and no added sounds. His abdomen is soft and non-tender with normal bowel sounds. You expose him and find no evidence of wounds to the head, neck, torso, abdomen or limbs.

Which of the following statements are correct?

Otoscopic examination reveals intact tympanic membranes and chest x-ray is normal. Does this patient need to be admitted to the hospital for observation or not, and why?