(Kiosk 1) Medically Complex Rehabilitation of Firework-related Blast Injury: A Case Report

Case Diagnosis: 56-year-old male with a past medical history of unspecified depressive disorder and mild alcohol use disorder presenting after a close-proximity firework trauma with blast injury leading to amputation of upper extremity (non-dominant), second and third degree burns of ~30% body surface area, rib fractures, mild traumatic brain injury, pulmonary contusion and hypovolemic shock

Case Description or Program Description: Patient presented with multiple injuries including left upper extremity amputation, extensive burns, rib fractures, and mild TBI after a firework misfired. The patient was intubated for airway protection and impending hypoxic respiratory failure then admitted to the surgical intensive care unit. He underwent transradial guillotine amputation of his left upper extremity followed by elbow disarticulation due to non-viable muscle and tissue. He underwent multiple debridements, washouts, and skin grafting.

Setting: Inpatient rehabilitation facility

Assessment/Results: The patient experienced significant decline in function from independent pre-morbidly to moderate-maximum assistance for transfers, hygiene activities, and dressing. His course was complicated by neurocognitive disturbances consistent with adjustment disorder and phantom pain of the residual arm. Patient was admitted to acute rehabilitation for physical, occupational, and neuropsychological therapy. His care was co-managed by surgery, nursing, and psychology and psychiatry for his therapies, comprehensive wound care, and mental health counseling.

Discussion (relevance): In 2021, an estimated 11,500 firework injuries were treated in US hospitals of which approximately 15% required hospital transfer or admission. Case incidence and severity increase yearly, making this condition’s presentation and management important for awareness. Common injury from fireworks include burns, blast trauma, limb loss, and psychological damage. These injuries pose a complex medical, surgical, and rehabilitation challenge.

Conclusions: Close-proximity blast injuries with survival is a rare care presentation and is often accompanied by multiple and severe sequelae. This case illustrates the importance of an intensive and multidisciplinary acute rehabilitation management team.