The Healing of broken wings: A case of paediatric firecracker injuries

Sangeetha1, Mercy Ezhil Rani2

1Casualty Staff Nurse, Kauvery Hospital, Hosur, Tamil Nadu

2Clinical Educator, Kauvery Hospital, Hosur, Tamil Nadu

Introduction

“How do we even begin to explain the situation he’s in?” the note seemed to ask, summarizing the grim prognosis. It was a case of a firecracker exploding too close, transforming a moment of childhood joy into a clinical nightmare. The list of his injuries read like a catalogue of trauma, a web of lacerations across his lips, forehead, and upper arm, each from the physical impact of the blast. The most significant finding was the presence of multiple metal and carbon particles, embedded deep in the smaller wounds on his chest, abdomen, and even his cranium. This wasn’t just a simple burn, it was an assault by shrapnel.

The team’s efforts were a desperate, measured attempt to fight back against the damage. They performed a meticulous wound wash. Debridement and suturing were done on September 18th. He was intubated to manage his breathing and prepare him for further procedures. A tracheostomy was performed under general anaesthesia on the same day. Two days later, on September 20th, a bilateral eye wound exploration and suturing were performed, again under general anaesthesia, to address the extensive damage to his eyes. Each step was a painstaking effort to repair and heal an injury that had been so violently inflicted on him.

Then came the day of a small victory. On September 23rd, the tracheostomy tube was decannulated, a procedure performed under local anaesthesia. It was a step toward recovery, a move that promised the hope of a normal breath and, one day, a normal life. This was the result of a concerted effort, struggle to restore hope against a backdrop of suffering. The journey was long and far from over, but the small triumphs were what sustained both the boy and the medical team caring for him.

The post-decannulation period was a time of cautious progress, of maintaining hope in a new reality. The boy, who had once struggled so desperately to breathe, was now breathing on his own. Our medical treatments had been successful, but the journey was far from over.

There was significant kidney damage, and for that, we had to seek further intervention from a urologist and samples were sent for culture and sensitivity tests. The medical team was seeking advanced opinions on how to proceed.

A new complication arose: a fluid imbalance that could lead to dehydration and further kidney issues. We treated it, but the fear of setbacks lingered.

On the 24th of September, the boy was successfully moved from the ICU to a regular ward. The journal entry notes the significance of the word “successfully,” capturing the small victory that brought a glimmer of hope, anticipation, and cheer to his face. The expression in his eyes changed from the despair of thinking, “I will never recover from this,” to a tiny, fleeting smile.

On the 27th of September, his eyesight, which had also been affected, was treated. A specialist eye doctor was consulted, and he underwent surgery.

After receiving the plan for his follow – up management he was finally sent home.

Palliative and rehabilitation care were initiated to support pain management, promote wound healing and assist in the patient’s functional recovery. Family members were also included in counseling and education sessions towards ensuring ongoing care and adaptation.

The final passage of the journal entry uses a beautiful, poignant metaphor:

“Like a bird with a broken wing,

whose feathers are slowly mended

and whose movements are gently guided.”

This is how we caregivers saw the child, a fragile being whose spirit was being carefully nurtured back to health.

He was a little boy slowly returning his world, just as a bird  found its nest again

We shall never forget  the pain he went through.

Nightingale Journals

Kauvery Hospital
Find Doctor
Book Appointment