4500 002 Blast Trauma Care

BLAST TRAUMA CARE COURSE MANUAL REFERENCE The ICRC would like to acknowledge the following doctors and medical staff for their contribution to the Blast Trauma Care Manual: • Enzo Chemello, Chief of emergency department, Pieve di Cadore Hospital, Italy • Katrine Finsnes, Anaesthetist, Stavanger University Hospital, Norway • Stefano Donato, Anaesthetist, Belcolle General Hospital, Italy • Mauro Dalla Torre, Medical Adviser, Weapon Contamination Unit, ICRC Switzerland BLAST TRAUMA CARE COURSE MANUAL CONTENTS INTRODUCTION .................................................................................................6 CHAPTER 1 – THE PHYSICS OF EXPLOSIONS ......................................................8 HOLLYWOOD VERSUS REALITY ................................................................................................ 8 EXPLOSIVES ......................................................................................................................................8 LOW AND HIGH EXPLOSIVES ................................................................................................... 8 PRIMARY AND SECONDARY EXPLOSIVES ............................................................................. 9 DEPLOYMENT, ARMING AND DETONATION ........................................................................ 9 EFFECTS OF EXPLOSIONS AND MECHANISMS OF INJURY .......................................... 10 CHAPTER 2 – EXPLOSIONS AND BLAST INJURIES ............................................ 14 PRIMARY BLAST INJURY .............................................................................................................17 SECONDARY BLAST INJURY ......................................................................................................20 TERTIARY BLAST INJURY ..........................................................................................................22 QUATERNARY BLAST INJURY ...................................................................................................22 QUINARY BLAST INJURY ............................................................................................................23 LUNG TRAUMA ..............................................................................................................................23 CHAPTER 3 – SAFETY FIRST! ...........................................................................26 BEFORE ENTERING THE SCENE .............................................................................................26 EVALUATE THE SCENE ...........................................................................................................26 ASSESS SAFETY ........................................................................................................................ 27 WEAR PERSONAL PROTECTIVE EQUIPMENT......................................................................28 ON THE SCENE ...............................................................................................................................29 PRIMARY SURVEY: PRIORITIZE CARE (cABCDE) ................................................................29 SECONDARY SURVEY .............................................................................................................. 33 DO A QUICK HEAD-TO-TOE CHECK ..................................................................................... 33 PACKAGING ..............................................................................................................................34 CHAPTER 4 – A/B: MANAGING THE AIRWAY AND RESPIRATORY SYSTEM ......36 THE AIRWAY AND RESPIRATORY SYSTEM .........................................................................36 AIRWAY OBSTRUCTIONS ...........................................................................................................39 VENTILATION .................................................................................................................................44 CHAPTER 5 – C: CIRCULATION AND BLEEDING CONTROL ...............................48 OXYGEN AND THE CIRCULATORY SYSTEM ........................................................................48 CAPILLARY REFILL TIME ....................................................................................................... 52 BLEEDING ........................................................................................................................................52 PRIMARY SURVEY ....................................................................................................................54 STOPPING BLOOD LOSS ..........................................................................................................54 DIRECT PRESSURE .................................................................................................................. 55 PACKING THE WOUND............................................................................................................56 TOURNIQUET ........................................................................................................................... 57 OTHER MAJOR BLEEDS ..........................................................................................................63 ADVANCED CONSIDERATIONS ................................................................................................63 SHOCK .......................................................................................................................................63 INTRAVENOUS LINES ..............................................................................................................64 HEMOSTATIC AGENTS ............................................................................................................65 CHAPTER 6 – D: HEAD AND SPINE INJURIES ...................................................68 EPIDEMIOLOGY .............................................................................................................................68 ANATOMY ....................................................................................................................................... 69 MECHANISMS OF INJURY ........................................................................................................ 69 COUP-CONTRECOUP MECHANISM ......................................................................................70 MASS MECHANISM .................................................................................................................70 SCALP WOUNDS ..............................................................................................................................71 SKULL FRACTURES ......................................................................................................................72 EARLY SIGNS OF A SKULL-BASE FRACTURE ...................................................................... 72 LATE SIGNS OF A SKULL-BASE FRACTURE......................................................................... 73 PENETRATING / IMPALED OBJECTS ......................................................................................73 INITIAL ASSESSMENT AND MANAGEMENT ......................................................................73 UNCONSCIOUS PATIENTS ......................................................................................................74 PATIENTS WITH ALTERED MENTAL STATUS ..................................................................... 75 PATIENTS WITH MILD HEAD TRAUMA ................................................................................ 75 SPINE INJURIES .............................................................................................................................76 EYE INJURIES..................................................................................................................................77 CHEMICAL BURNS ................................................................................................................... 77 SMALL FOREIGN OBJECTS ..................................................................................................... 77 PENETRATING EYE INJURY .................................................................................................... 78 NOSE INJURIES ..............................................................................................................................78 CHAPTER 7 – CHEST, ABDOMEN AND GENITALIA INJURIES ...........................80 CHEST ................................................................................................................................................80 SIGNS AND SYMPTOMS .........................................................................................................82 RIB FRACTURES ...................................................................................................................... 83 OPEN / TENSION PNEUMOTHORAX ......................................................................................84 IMPALED OBJECT ....................................................................................................................86 HAEMOTHORAX ......................................................................................................................86 SMOKE INHALATION / THERMAL INJURY / CARBON MONOXIDE POISONING .............. 87 ACUTE RESPIRATORY DISTRESS SYNDROME ..................................................................... 87 CARDIAC CONTUSION / TAMPONADE ..................................................................................88

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