Update on diagnosis and treatment
Crit Care Med 2008; 36:[Suppl.]:S311–S317
Injuries from explosions are traditionally classified into:
- Primary blast injuries: injuries due solely to the blast wave
- Secondary blast or explosive injury: primarily ballistic trauma resulting from fragmentation wounds from the explosive device or the environment
- Tertiary blast or explosive injury: result of displacement of the victim or environmental structures, is largely blunt traumatic injuries
- Quaternary explosive injuries: burns, toxins, and radiologic contamination
- Ophthalmology consultation should be obtained for suspected globe injuries, corneal foreign bodies or abrasions, orbital fractures, retinal detachments, hyphema, intraocular foreign bodies, corneal or eyelid burns, lid lacerations, subconjunctival hemorrhage, or head injuries that involve the orbit or may compromise vision
- Tympanic membrane rupture is the most common primary blast injury
- Clinicians should make otoscopic examination a routine part of the initial evaluation of explosion injured patients
- Blast lung injury is the most common fatal injury among initial survivors of explosions
- Clinical diagnosis of blast lung injury is based on the presence of respiratory distress, hypoxia, and “butterfly” or batwing infiltrates.
- Triad of immediate bradycardia, hypotension, and apnea.
- Mesenteric or mural hematoma in hemodynamically stable patients without peritoneal signs may be managed with NPO, NG tube decompression, and resuscitation.
- Massive hemorrhage or obvious hollow viscus perforation should be treated with laparotomy for hemostasis and control of spillage of enteric contents.
- Early tourniquet use
- PE should include a thorough NE to include checking for positive Romberg's sign as well as funduscopy to look for evidence of air emboli.
- CT scan should be used to search for evidence of blunt head injury and ICH.
Patient Risk Stratification