Blast Injuries • • • • Prehospital ManagementConsiderations • • • Clinical Presentation highestrisk.at BLIpresentsuniquetriage, diagnostic, challenges. andmanagement obvious externalchestinjury. Persons inenclosed-space explosionsorinclose proximitytotheexplosionare injury—or, BLI. difficultyandhypoxia. Itischaracterizedbyrespiratory BLIcanoccur, althoughrarely, without withtheseinjuries.patients isblastlung uponthebody Onedirectconsequenceofhigh-explosivedetonations explosions, experiencetreating have yetfewcivilianemergency providersintheUnitedStates medicalservice to increasedthepotentialforcasualtiesrelated inworldwideterroristactivityhave Current patterns Background • • • • Prehospital Care Providers Blast  —  —  —     Symptomsmayinclude dyspnea, hemoptysis, cough, andchestpain.    Hemothoracesorpneumothoracesmayoccur. surface area (BSA) are more likely to have BLI.surface area(BSA)aremorelikelytohave Victims withskullfractures, torsoorhead, injuriespenetrating orburns coveringmorethan10%body observation is warranted for any patient suspectedofBLI whoistransportedbyair. patient iswarranted forany observation clinicallydecompression shouldbeperformed forpatients presenting withatensionpneumothorax. Close Clinical evidenceorsuspicion ofahemothoraxorpneumothoraxwarrantsclose observation. Chest hypoxemia. oxygentoprevent Patients withsuspectedorconfirmedBLIshouldreceivesupplementalhigh-flow Note thepatient’s thetimeofinjury. andthesurroundingenvironmentat location blastinjury,Explosions inconfinedspacesresultahigherincidenceofprimary including lunginjury. ormasscasualties.injured patients Initial triage, traumaresuscitation, standardprotocolsformultiple shouldfollow and transportofpatients instability.hemodynamic Signs mayinclude tachypnea, hypoxia, cyanosis, apnea, wheezing, sounds, decreasedbreath and Other injuriesareoftenpresent. 24to48hoursafteranexplosion.BLI canappear however, theinitialevaluation; Clinical evidenceofBLIistypicallypresentat evidenceof that reportsshow system,embolic eventsinvolvingthecentralnervous retinalarteries, arteries. orcoronary orvasculartearing,Due topulmonary (airemboli)andresult in airmayenterthearterialcirculation A compromised airway requires immediate intervention.A compromisedairwayrequiresimmediate placed inaprone, semi-leftlateral, position. orleftlateral oxygenshould beadministeredifairembolismissuspected,High-flow should be andthepatient alveolar rupture, pneumothorax, andairembolismin BLIpatients. andpositivepressuremayincreasetherisk of mechanicalventilation providers mustrealizethat failureisimminentoroccurs, however, shouldbeintubated; If ventilatory patients prehospital L ung Injury: A n Overview for

Blast Lung Injury: Prehospital Care Providers Blast Lung Injury: Prehospital Care Providers June 2009 **High flow oxygen, transport.**High flow andrapid appropriate, as foradditionalinjury airwaymanagement evaluate *There isahigherincidenceofBLIinenclosed spaces. Blast LungInjuryManagementProtocol • • Prehospital ManagementConsiderations   community responseplansformasscasualtyevents. tothenearest,Patients withBLIshouldbetransportedrapidly facility, appropriate inaccordancewith status.result involumeoverloadandworsenpulmonary Fluids shouldbeadministeredjudiciously, withBLImay inthepatient asoverzealousfluidadministration This fact sheet is part of a series of materials developedbytheCentersforDiseaseControl This factsheetispartofaseriesmaterials and Prevention(CDC)onblastinjuries. For moreinformation, visitCDConthe Web at: No Transport tothe rapidly mass casualtyevents. facility inaccordance nearest, appropriate response plansfor with community Appropriate Treatment Respiratory Distress Respiratory suggestive ofBLIor Signs orsymptoms Compromised ** Transport explosive event monitor I.V. Vital signs, ** oxygen, Ventilation Blast or No and

www.emergency.cdc.gov/BlastInjuries. suspicion ofBLIwhoistransported clinically presentingwithatension observation. Chestdecompression pneumothorax. Closeobservation should be preformed for patients should bepreformedforpatients is warranted for any patient with patient is warrantedforany Yes Suspicion forahemothoraxor peumothorax warrantsclose Initial triage, traumaresuscitation, standard protocolsformultiple *inanopenorclosed space? and transport should follow and transportshouldfollow intubated; however,intubated; cautionshouldbeusedasmechanicalventilation and positivepressuremayincreasetheriskofalveolarrupture or masscasualties. injured patients injured patients If ventilatory failure isimminentoroccurs, shouldbe If ventilatory patients by air. (continued) management management protocol Airway

air embolism. penetrating torsoorheadinjuries. penetrating BSA burns, skullfractures, and trauma. for>10% patient Evaluate chest trauma, andbluntchest (source ofairembolism), penetrating and hemorrhage, A-V fistulas pneumothorax, contusion pulmonary Blast lung, hemothorax, Clinical concerns chest pain Dyspnea, hemoptysis, cough, and Symptoms ofBLI hemoptysis sounds,decreased breath or wheezing, dullnesstopercussion, hypoxia andcyanosis, cough, Apnea, tachypneaorhypopnea, Signs ofBLI much fluid may result in volumeoverload administrating too administrating pulmonary status. pulmonary and worseningof be administered Fluids should judiciously, if required, as 202792-A