Blast Injuries • • • Management • • • Diagnostic Evaluation • • • • Clinical Presentation injuriesfromexplosions. totreat abouthow information the presentation, evaluation, management, andoutcomesofBLIs. formore Pleaseseethereferencelistbelow canresult.and othertypesofinjuriesthat Basicclinical isprovidedheretoinformpractitioners of information injuries.explosion-related Emergency careprovidersareurgedtolearnmoreaboutthephysicsofexplosions with explosions, patients experiencetreating have yetfewcivilianhealthcareprovidersintheUnitedStates to increasedthepotentialforcasualtiesrelated inworldwideterroristactivityhave Current patterns tothechest. which mayoccurwithoutobviousexternalinjury perfusion mismatch. difficultyandhypoxia, BLIisaclinical andischaracterizedbyrespiratory diagnosis impact uponthelungresultsintearing, hemorrhage, contusion, andedemawithresultantventilation- thesceneandamonginitialsurvivors.morbidity andmortalityforblastvictimsbothat The blastwave’s uponthebody. fromhighexplosivedetonations consequence oftheblastwave BLIisa majorcauseof (BLI)presentsuniquetriage,Blast lunginjury diagnostic, challengesandisadirect andmanagement Background Blast LungInjury Clinical interventions Clinical interventions ensuringtissueperfusionwithout volumeoverload.and administration In general, contusion, BLIissimilartocaringfor pulmonary managing whichrequiresjudiciousfluiduse optionsmaybelimitedinadisasterormasscasualtysituation. ortherapeutic diagnostic Initial triage, trauma resuscitation, treatment, some standardprotocols;however andtransfer shouldfollow or extrication, suspected chemicalorbiologicevent, etc). of theexplosion(e.g. confinedspace, fire, prolonged entrapment protocols andfurtherdirectedbaseduponthenature resuscitation testingcanbeconductedper anddiagnostic Most laboratory maybeused.technology Arterial bloodgases, computerizedtomography, anddoppler A characteristic “butterfly” mayberevealeduponx-ray. pattern whoisexposedtoablast. foranyone isnecessary Chest radiography Other injuriesmaybepresent. pneumothoraces. mayinclude pathology bronchopleuralfistula,Associated airemboli, and hemothoracesor instability.hemodynamic Signs mayinclude tachypnea, hypoxia, cyanosis, apnea, wheezing, sounds, decreasedbreath and Symptoms mayinclude dyspnea, hemoptysis, cough, andchestpain. Photo courtesyofChest, 1999

Blast Lung Injury Blast Lung Injury June 2009 year follow-up”, by Hirshberg, Boaz, MD, etal. Dec1999, Vol 116(6), p1683-88. Photo Source: ReprintedbypermissionfromChest. X-rayFigure Iin fromBlastLungInjury:“Recovery One • • • • • Disposition andOutcome • • • • • Management (continued) physical examinations andchestradiographs,physical examinations andmosthadnormallungfunctiontests. oneyearpostinjury, conductedonsurvivors study complaints, hadpulmonary nopatients allhadnormal withBLIiscurrentlylimited. ontheshortandlong-termoutcomesofpatients Data However, inone BLI, canbeconsideredfordischargeafter4-6hoursofobservation. In general, and withnormalchestradiographs patients ABGs, wouldsuggest nocomplaintsthat whohave including thepatient’s currentsocialsituation. injuries,Discharge decisionswillalsodependuponassociated totheevent, andother issues related care unit. inthehospital. complaintsorfindingssuspiciousforBLIshouldbeobserved Patients withany andshouldbeadmittedtoanintensive withBLImayrequirecomplexmanagement Patients diagnosed anexplosion. with possible BLIfollowing forpatients department evaluation There arenodefinitiveguidelinesforobservation, admission, emergency ordischargefollowing hyperbaric chamber. in prone, semi-leftlateral, positions. orleftlateral forairembolishouldbetransferredtoa Patients treated oxygenshouldbeadministeredifairembolismissuspected,High flow shouldbeplaced andthepatient risk ofalveolarruptureandairembolism. patients,in thedecisiontointubate andpositiveendpressuremayincreasethe asmechanicalventilation failureisimminentoroccurs, however, shouldbeintubated; If ventilatory patients cautionshould beused Clinical evidenceoforsuspicionforahemothoraxpneumothoraxwarrantspromptdecompression. from selectivebronchusintubation. tosecuretheairway.intervention Patients withmassivehemoptysisorsignificantairleaksmaybenefit Impending airwaycompromise, edema, secondary injury, ormassivehemoptysisrequiresimmediate endotracheal intubation). mayinclude masks,prevent hypoxemia(delivery non-rebreather continuouspositiveairwaypressure, or oxygensufficientto withsuspectedorconfirmedBLIshouldreceivesupplementalhighflow All patients This fact sheet is part of a series of materials developedbytheCentersforDiseaseControl This factsheetispartofaseriesmaterials and Prevention(CDC)onblastinjuries. For moreinformation, visitCDConthe Web at: www.emergency.cdc.gov/BlastInjuries. 202792-A