Blast injuries: from triage to critical care

High risk and low prevalence diseases: Blast injuries

INTRODUCTION

Blast injury is a unique condition that carries a high rate of morbidity and mortality, often with mixed penetrating and blunt injuries.

OBJECTIVE

This review highlights the pearls and pitfalls of blast injuries, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.

DISCUSSION

Explosions may impact multiple organ systems through several mechanisms. Patients with suspected blast injury and multisystem trauma require a systematic evaluation and resuscitation, as well as investigation for injuries specific to blast injuries. Blast injuries most commonly affect air-filled organs but can also result in severe cardiac and brain injury. Understanding blast injury patterns and presentations is essential to avoid misdiagnosis and balance treatment of competing interests of patients with polytrauma. Management of blast victims can also be further complicated by burns, crush injury, resource limitation, and wound infection. Given the significant morbidity and mortality associated with blast injury, identification of various injury patterns and appropriate management are essential.

CONCLUSIONS

An understanding of blast injuries can assist emergency clinicians in diagnosing and managing this potentially deadly disease.

Evaluation of blast injury patients from the 2015 Tianjin explosions in China

OBJECTIVES

To perform a descriptive analysis of blast injury patients from the Tianjin explosions that occurred August 12, 2015 and provide a reference for triage and treatment of patients in similar situations in the future.

METHODS

The medical records of patients with blast injuries admitted to our hospital following the 2015 Tianjin explosions were retrospectively reviewed. The results were compared with the literature for other recent mass casualty events.

RESULTS

The 75 patients with blast injuries included 58 men (77.3%) and 17 women (22.7%), who had an average age of 36.39±12.3 years. Multidimensional injuries affecting almost every organ system were observed in these patients. The distribution of the types of blast injuries included 36 (48.0%) with primary blast injuries, 63 (84.0%) with secondary injuries, 33 (44.0%) with tertiary injuries and 32 (42.6%) with quaternary injuries. A total of 52 (69.3%) patients suffered more than two types of blast injury. Burns affecting different areas and different depths were present in 41.3% of the patients with blast injuries, and these were divided into the following four groups: a minor group (18.7%), a moderate group (10.7%), a severe group (5.3%), and an extra severe group (6.7%). The total body surface area (TBSA) affected by the burn ranged from 1% to 75%. Additionally, 6.7% of the patients were diagnosed with an inhalational injury, and 2.7% of the patients were diagnosed with chemical poisoning. There were significant differences in the department distribution (especially in the burn unit and ophthalmology department) and ICU treatment between civilians and firefighters.

CONCLUSION

Various types of injury, with overlapping injuries present in many patients, were observed in the victims after the Tianjin explosions. An evaluation of the distribution of blast injuries is important for optimizing strategies to triage and treat survivors after mass casualty events.

Blast Injuries

BACKGROUND

Blast injuries in the United States and worldwide are not uncommon. Partially due to the increasing frequency of both domestic and international terrorist bombing attacks, it is prudent for all emergency physicians to be knowledgeable about blasts and the spectrum of associated injuries.

OBJECTIVE

Our aim was to describe blast physiology, types of blast injuries associated with each body system, and manifestations and management of each injury.

DISCUSSION

Blast injuries are generally categorized as primary to quaternary injuries. Primary injuries result from the effect of transmitted blast waves on gas-containing structures, secondary injuries result from the impact of airborne debris, tertiary injury results from transposition of the entire body due to blast wind or structural collapse, and quaternary injuries include almost everything else. Different body systems are affected and managed differently. Despite previous dogma, multiple studies now show that tympanic membrane perforation is a poor predictor of other blast injury.

CONCLUSIONS

Blast events can produce a myriad of injuries affecting any and every body system. All emergency physicians should be familiar with the presentation and management of these injuries. This knowledge may also be incorporated into triage and discharge protocols guiding management of mass casualty events.

Advancing critical care: joint combat casualty research team and joint theater trauma system

Despite the severity and complexity of injuries, survival rates among combat casualties are equal to or better than those from civilian trauma. This article summarizes the evidence regarding innovations from the battlefield that contribute to these extraordinary survival rates, including preventing hemorrhage with the use of tourniquets and hemostatic dressings, damage control resuscitation, and the rapid evacuation of casualties via MEDEVAC and the US Air Force Critical Care Air Transport Teams. Care in the air for critically injured casualties with pulmonary injuries and traumatic brain injury is discussed to demonstrate the unique considerations required to ensure safe en route care. Innovations being studied to decrease sequelae associated with complex orthopedic and extremity trauma are also presented. The role and contributions of the Joint Combat Casualty Research Team and the Joint Theater Trauma System are also discussed.

The role of occupational health nurses in terrorist attacks employing radiological dispersal devices

The potential for biological, chemical, radiological, or nuclear terrorism has been widely acknowledged since the events of September 11, 2001. Terrorists' use of a radiological dispersal device (RDD), or dirty bomb, is considered to be a threat for which Americans must prepare. Occupational health nurses must have the knowledge and skill set to plan for, respond to, and recover from a radiologic event potentially affecting significant numbers of first responders as well as businesses and their workers. This article describes the hazards related to RDDs and provides resources supporting occupational health nurses' roles in such events occurring near or at their workplaces. Occupational health nurses are prepared to assess and treat RDD causalities using current information to identify signs and symptoms of exposed and contaminated RDD victims. Decontamination, treatment, and recovery methods for workers and businesses affected by an RDD event are described.