Blast Injuries • • • • • • • • • • • • Lung Injury Primary BlastInjury • • Blast Injuries • • • • • Key Concepts • • Essential Facts For and firstreceivers offirstresponders contamination radiologicalsecondary Universal precautionseffectivelyprotectagainst ofthevictim;riskexposuretocaregiversissmall contamination Triage proceduresshould neverbedelayedbecauseofthepossibilityradioactive andlifesaving thepotentialforchemicaland/orradiologicalcontamination All bombeventshave exposedtoablast examineandassesspatients Repeatedly arepredominantlyseeninconfinedspaceexplosions blastinjuriesinsurvivors Primary morbidityandmortality with greater O2sufficienttopreventhypoxemiavia NRBmask, High flow CXR: withdyspnea, Suspect inanyone Varies petechiae toconfluenthemorrhages fromscattered to theheadortorso withskullfractures, Reported tobemorecommoninpatients timeofinitialevaluation, Signs usuallypresentat Secondary: — Primary: Explosions inconfinedspaces(buildings, injuriesandblunttrauma Predominant injuriesinvolvemultiplepenetrating Most severelyinjuredarriveafterthelessinjured, Expect halfofallinitialcasualtiestoseekmedicalcareoveraone-hourperiod seldomseenoutsidecombat ofinjury Bombs andexplosionscancauseuniquepatterns — Quaternary: — Tertiary: — tetanustoxoidvaccine(ifnotcurrent) (within 7days)andage-appropriate those TM rupture, Crush injuries, trauma, Blunt/penetrating Penetrating trauma,
“butterfly” Injuriesfromdisplacementofvictimbytheblastwind fromover-pressurization surface impactingthe body Injury force(blastwave) with fromprojectiles(bombfragments, Injury
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injuries andairembolization, damage pulmonary pattern burns, resulting injuries, fragmentation asphyxia, fractures, in cough, nonintact toxicexposures, amputations andtraumatic hemoptysis, largevehicles, skin andgodirectlytotheclosest whobypassEMStriage hospitals blunttrauma butmaybedelayedupto48hours or mucous ofchronic illness exacerbations flyingdebris) blast orchestpainfollowing areassociated mines)and/orstructuralcollapse viscusinjury hollow CPAP, membrane >10%BSAburns, orETtube exposure, injury andpenetrating
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Essential Facts Essential Facts June 2009 • Disposition • • • • • Primary BlastInjury(continued) • • • • • • • • • • Abdominal Injury • • • Other Injury • • Ear Injury • No definitiveguidelinesforobservation, Air embolismcanpresentasstroke, Consider prophylacticchesttubebeforegeneralanesthesiaorairtransport Prompt decompressionforclinical evidenceofpneumothoraxorhemothorax — forsignificantairleaksormassivehemoptysis — Considerselectivebronchialintubation formassivehemoptysis, Endotracheal intubation volumeoverload contusion;ensuretissueperfusionbutavoid similartopulmonary Fluid management andinstructionsmayneedtobewritten tinnitusordeafness;communications mayhave Patients withearinjury ofwounds, Close follow-up Admit 2ndand3rdtrimesterpregnanciesformonitoring injuries Discharge decisionswillalsodependuponassociated seriouseyeinjuries willhave ofsurvivors Significant percentage Consider possibilityofexposuretoinhaledtoxins(CO, prolonged extrication, Compartment syndrome, withabdominalpain, Suspect inanyone organ lacerations, perforation, Bowel Gas-filled structuresmostvulnerable(esp. — ConsidertransferforhyperbaricO2therapy O2;prone, — Highflow closure wounds, Consider delayedprimary forgrosslycontaminated Concussions arecommonandeasilyoverlooked Traumatic limbisamarkerformulti-systeminjuries ofany amputation external canal, (hearingloss, usuallyevidentonpresentation Signs ofearinjury Tympanic blastinjury membranemostcommonprimary Clinical signscanbeinitiallysubtleuntilacuteabdomenorsepsisisadvanced pain, Positive pressuremayriskalveolarruptureorairembolism unexplainedhypovolemia This fact sheet is part of a series of materials developed bytheCentersforDiseaseControl This factsheetispartofaseries ofmaterials and Prevention(CDC)onblast injuries. For moreinformation, visitCDConthe Web at: otorrhea) andtesticularrupture (smallpetechiaetolargehematomas), hemorrhage severeburns, semi-leftlateral, rhabdomyolysis, headinjury, www.emergency.cdc.gov/BlastInjuries. MI, andsomepoisonings acuteabdomen, eye, admission, nausea, position orleftlateral withstructuralcollapse, andacuterenalfailureareassociated colon) ear, complaints andstress-related vomiting, failure impendingairwaycompromiseorrespiratory ordischarge CN, blindness, MetHgb)inbothindustrialandterroristexplosions hematemesis, tinnitus, deafness, status andassesstetanusimmunization mesentericshearinjuries, otalgia, rectalpain, spinalcordinjury, vertigo, tenesmus, bleedingfrom claudication testicular solid
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