BLAST INJURIES • • • • mayrequiretimelyintervention. that Forinjury example, canbeusedasfollows: radiologicalimaging byidentifyinglife-threatening helpstoprioritizetreatment blastinjury ofsecondary Radiological diagnosis regionofthebody, ofany penetration regions. inmultiple body penetrations fragment andtypicallyhave trauma, primarilycausespenetrating blast injury butmayalsocauseblunttrauma. Patients cansustain issecondarilypropelled bytheexplosion.It canalsoresultfromdebrisexternaltothebombthat Secondary of thebombinadditiontoobjectsaddeddeviceincreaselethality(e.g., screws, nails, nutsand bolts). is characterized by trauma due to impact from bomb fragments, Blast Injury Secondary to include the casing • • and pneumothorax. alveolarhemorrhage todiffusepulmonary secondary opacification barotrauma ischaracterizedbypulmonary andentericbarotrauma. focusesonpulmonary blastinjury Pulmonary ofprimary Radiological diagnosis reflection ofsurfacesasseenin closed-space explosions(e.g., insideabuilding, bus, train). affecting air-filled suchastheear, organsandcavities lung, and abdomen. bythe ismagnified Thisblastwave producedbyhigh-orderexplosives, iscausedbytheoverpressureblastwave BlastInjury primarily Primary Initial Evaluation oftheexplosiveinjuredpatient. essential elementintheoptimizingmanagement andisan andtriage resourceshasthepotentialtoimpactin-hospitaldiagnosis ofradiology utilization ofresources.multiplicity ofinjurieswhichrequireahigherallocation With thiscaveat, theappropriate and mechanismsarethenumberofpatients andotherinjury injury difference betweenexplosion-related overwhelmed. resourcescanberapidly mass casualtyeventsinwhichhumanandmaterial Onesignificant experiencewith fewprovidersormedicalfacilitieshave bythefactthat of thisscenarioisexacerbated thepotentialtoinflictnumerouscasualtieswithmultipleinjuries.Explosive eventshave Thecomplexity Background Radiological Diagnosis whodonotneedsurgicaltherapy. injured byfragments The CTscancanbeused toidentifypatients penetrations. withblastfragment stable patients hemodynamically injuries,The thoracoabdominalCTscancanbeusedtoidentify unapparent including among penetration.) cavity sensitive forbody injury,intracavitary whothenwillrequire moreadvancemethodsofimaging. (Conventionalx-rayisnot woundssuspiciousforcausing withfragment Conventional x-raycanbeusedtoidentifypatients Portable patterns. biplanarx-raycanbe used todefinebasicpenetration   radiography. freeairthandoesconventional sensitivityforthedetectionofintraperitoneal (CT) hasamuchgreater freeair. manifestingasintraperitoneal injuries istoidentifyentericinjury Computerizedtomography In theabsenceofperitonitisorclinical signs, blast theroleofradiologicalstudiesinassessingprimary may include dyspnea, tachypnea, andcyanosis. test. isaconfirmatory A chestradiograph symptomswhich oftenpresentwithsignificantpulmonary blastinjury Patients withsubstantialpulmonary

Radiological Diagnosis Radiological Diagnosis June 2009 • • medical providers. challengesforemergencyThe severityanddiversityofinjuriescausedbyexplosionsprovidetreatment Summary andDisposition • • • • detection ofotherinjuries. For example: primarilyfocusesonidentifyingfractures, blastinjury oftertiary butalsoincludesRadiological evaluation the sharp object). primarily involveblunttrauma, butmayalsobeclassified trauma(e.g., aspenetrating impalementon Tertiary bytheforceofblastwind. resultsfromthevictimbeingthrown blastinjury These injuries Initial Evaluation(continued) the accuracy andenhancetreatment. ofdiagnosis resourcespermit,If radiography phasetoincrease shouldbeusedliberallyintheacutediagnostic imaging interventions.of life-and-limbsaving need withthegreatest ofpatients andinidentification triage resources isvitallyimportantduringpatient anexplosion,Due tothepotentialforsurgeandnearbyhospitalsfollowing effectiveuseofradiology pathology.for determiningtraumatic blastinjury, algorithmforthesecondary Similar tothediagnostic theCTscanisbothsensitiveandspecific to beblood. withblunt-forcetraumainjuries. fluidinpatients intraperitoneal Inexplosiveevents, thisfluidispresumed Focused abdominalsonogramfortrauma(FAST) thepresenceof diagnose canbeusedtorapidly Pelvic isusedtoexclude radiography ofpelvisfractures. ortodeterminethemorphology contusion, consistentwithacutethoracicaorticinjury. aswellstigmata thethoraxforsignsofpneumothorax,Plain filmsareusefulinevaluating hemothorax, orpulmonary This fact sheet is part of a series of materials developedbytheCentersfor DiseaseControl This factsheetispartofaseriesmaterials and Prevention(CDC)onblastinjuries. For moreinformation, visitCDConthe Web at: www.emergency.cdc.gov/BlastInjuries. 202792-A