Blast Injuries • Diagnostic Evaluation • • • • • until theonsetofcomplications: unexplained hypovolemia, findingssuggestiveofanacuteabdomen. orany Clinicalfindingsmaybeabsent to anexplosionwithabdominalpain, nausea, vomiting, hematemesis, rectalpain, tenesmus, testicularpain, solid organlacerations, andtesticularrupture. exposed shouldbesuspectedinanyone Blastabdominalinjury perforation,bowel (rangingfromsmallpetechiaetolargehematomas), hemorrhage mesentericshearinjuries, blasteffect.Gas-containing sectionsoftheGItractaremostvulnerabletoprimary This cancauseimmediate Clinical Presentation anatomy. (For pleaserefertoCDC’s furtherinformation “Blast Injuries: Pediatrics” factsheet.) of abdominalinjury. duetotheirunique Childrenaremorepronetoabdominalinjuriesinblastsituations risk oftheblast. asignificantlygreater andthenature depending uponthepatient blastscarry Underwater isunknown. significantly blast injury willvary Incidenceandclinical ofabdominalblastinjury presentation anddeath.Abdominal blastinjuriesareasignificantcauseofinjury Theactualincidenceofabdominal Background Abdominal BlastInjuries —  studies — Laboratory — Serialabdominalexaminations, maybedelayed;serial exams maybedifficultinyoungchildren aspresentation Work-up abdominaltrauma similartostandardblunt andpenetrating toabdomenandabdominalwall — Quaternary: crushinjury — — Secondary: andbluntabdominal trauma penetrating (colonmostvulnerabletoperforation) — Primary: andperforation abdominalhemorrhage Most commonabdominalblastinjuriesinclude: larger organsrenderchildrenmorevulnerabletoinjuries,— proportionately especiallytoliverandspleen — thinabdominalwallsofferlessprotection — smallerandmorepliablewallsofferlessprotection Children aremorepronetoabdominalblastinjury incompressibilityofwater. withdistancedue totherelative toloseenergy slower fasterandare propagate ofasimilarexplosioninairbecausewaves explosion isaboutthreetimesthat blasts;thelethalradius ofanunderwater Abdominal injuriesareparticularlysevereinunderwater toarterialgasembolism. secondary blastinjury), andtertiary butinclude blastinjuries,blunt trauma(secondary primary including ischemia and involvestandardpenetrating Predominant post-explosionabdominalinjuriesamongsurvivors blastinjuries,primary including abdominalinjury. signs andsymptomsofhypovolemiaorhemorrhage. Victims ofclosed riskformore spacebombingsareat abdominal pain, reboundtenderness, guarding, sounds, absentbowel nauseaandvomiting, fever, and maybeovert, ofabdominalblastinjury Clinical presentation orsubtleandvariable, andmayinclude: Tertiary: abdominal trauma bluntandpenetrating contusion/laceration, intra-abdominalabscess Radiological studies: free air, unexplainedileus, intra-abdominalhematoma/hemorrhage, solidorgan

Abdominal Blast Injuries Abdominal Blast Injuries June 2009 • • Disposition • • • • • • Initial Management Appropriate referraltotraumacenterasneeded Appropriate manifestafterdischarge and strictreturninstructionsshouldsignsorsymptomsofabdominalinjury High degreeofsuspicionformissedordelayedabdominalinjuries, including serialexams, close follow-up, for Sonography Trauma (FAST) Radiological studies: plainabdominalfilms, [CT]scan, computedtomography Focused Abdominal monitoring Serial examsandlaboratory Antibiotics andtetanusimmunization duetoriskofhemorrhage) objectsinemergencyAvoid removalofpenetrating intervention room(operative Nothing bymouth ABCs (airway, breathing, asforalltraumapatients circulation) 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