Dear Friends,
Our hospital in Kunduz, in northern Afghanistan, is in a largely rural province where lots of people have agricultural livelihoods. We are a specialised trauma centre, so we are used to seeing patients with open wounds from falls, traffic accidents and explosives.
One day, a young boy arrived in critical condition. He was around eight years old. Ishaq* had been playing near his home when he picked up an unfamiliar object. When he tried to open it to see what it was, it exploded.
Ishaq’s family acted fast. They used a scarf, desperately trying to stop the bleeding as they rushed him to our trauma centre. In our emergency room, we assessed Ishaq quickly. He had many penetrating wounds, multiple fractures, and part of his hand had been blown off. The injuries to his torso were so extensive that his intestines were exposed.
His family’s rapid actions kept him alive long enough to get to the hospital, and as a team we raced to stabilise him.
When we assess a patient in a condition like Ishaq’s, we use the C-ABCD approach – catastrophic bleeding, airways, breathing, circulation, disability. This not only helps prioritise the actions most likely to save someone’s life, it also helps us monitor for changes in their condition. But the explosion meant Ishaq’s wounds were covered in dust and dirt and penetrated deeply – the chance of infection was extremely high.
In the following days, Ishaq developed sepsis and went into septic shock. In sepsis, the infection causes a patient’s blood vessels to expand, creating more space inside them. The extra space means the pressure that allows the blood to be pumped around the body starts to drop.
