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Author Credentials

Carol Wright Becker, MD Department of Emergency Medicine Roger D. Tillotson, MD Department of Emergency Medicine William Krantz, MD Department of Radiology Brad End, MD Department of Emergency Medicine Stephanie Rellick, PhD. Department of Emergency Medicine Emily Nutter a Department of Emergency Medicine b Department of Radiology

Author ORCID Identifier

https://orcid.org/0009-0007-1016-768X

Keywords

explosion; rural; lateral canthotomy; Cushing’s Triad; case report

Disciplines

Medical Physiology | Medicine and Health Sciences

Abstract

Explosions can lead to numerous injuries.1 Studies show that trauma mortality increases by 14% when patients are treated at rural hospitals compared to non-rural facilities.2 A 43-year-old male arrived at a rural hospital with injuries from an explosion, where only a single board-certified emergency physician was on duty. The patient's polytrauma was severe, resulting in bilateral orbital compartment syndrome and Cushing's triad. Remarkably, he survived these extensive injuries. Despite the limitations of rural healthcare, such as restricted equipment, medications, and longer transfer times, rural emergency physicians should remain optimistic and help guide future management. This high-acuity, low-frequency trauma case underscores the necessity for board-certified emergency physicians to be present in all emergency departments, including those in rural critical access hospitals. Rural emergency physicians should stay optimistic despite limitations in rural care, such as limited equipment, medications, and prolonged transfer times, and help guide future management. This unique case of high-acuity, low-frequency trauma presenting to a rural single-provider emergency department supports the need for emergency physicians to staff all emergency departments, including those in rural critical access hospitals.

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