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Shao J, Zhu Z, Xu B, Wang S, Jin R, Yang M, Zhang W, Han C, Wang X. Triage and Evaluation of Blast-Injured Patients in Wenling Liquefied Petroleum Gas Tanker Explosion. J Burn Care Res 2023; 44:1492-1501. [PMID: 37184046 DOI: 10.1093/jbcr/irad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Indexed: 05/16/2023]
Abstract
On June 13, 2020, a liquefied petroleum gas tanker exploded in Wenling. Here, the authors describe the mass casualty emergency response to the explosion. The authors collected the medical records of 176 inpatients at 8 hospitals in Taizhou and Hangzhou. The 176 inpatients with blast injuries comprised 70 females and 106 males, with an average age of 45.48 ± 19.96 years, and more than half of the patients were farmers. They were transported to six hospitals distributed around the explosion site in Taizhou in the initial rescue period and were grouped according to their new injury severity score as having mild, moderate, severe, or extremely severe injuries. Most patients with severe and extremely severe injuries were admitted to a superior hospital for postsecondary triage. Forty-four patients experienced primary blast injuries, 137 experienced secondary blast injuries, 37 experienced tertiary blast injuries, and 40 patients experienced quaternary blast injuries. Multiple blast injuries were suffered by 62 patients. Most patients (95.45%) suffered external injuries, with the chest, extremities, and face as the main affected areas. Burns were diagnosed in 26 adults, of whom 15.38%, 19.23%, 7.70%, and 57.69% suffered mild, moderate, severe, and extremely severe cases. Sixteen burn patients suffered from burn-blast injuries. Upper limbs and the head/face/neck area, as exposed areas, were more likely to experience a burn injury. Inhalation was the main accompanying injury. Of the eight patients who died in the prehospital session, seven had burn injuries. This report on the accident and injury characteristics of an open-air LPG-related explosion will facilitate responses to subsequent catastrophes.
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Affiliation(s)
- Jiaming Shao
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Zhikang Zhu
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Bin Xu
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Shuangshuang Wang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
- Department of Burns, The First People's Hospital of Wenling, Taizhou, 317525, China
| | - Ronghua Jin
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Min Yang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Wei Zhang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Chunmao Han
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
| | - Xingang Wang
- Department of Burns & Wound Care Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
- Key laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Emergency and Critical Disease
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Korkmaz İ, Çelikkaya ME, Atıcı A. Secondary blast injury: radiological characteristics of shrapnel injuries in children. Emerg Radiol 2023; 30:307-313. [PMID: 37039928 DOI: 10.1007/s10140-023-02132-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/31/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE The aim of this study is to examine the radiological images of child victims suffering from secondary blast injuries, to reveal organ-based injury patterns and their interrelationships, and to record mortality rates that may develop due to injured systems. METHODS A total of 65 patients with secondary blast injury due to bomb explosion were included in the study. Injury findings due to shrapnel in radiologic images of the patients were examined. Injured systems and types of injuries were recorded. RESULTS The most common injuries were intra-abdominal injuries (63%) and fractures (58.5%). Lung injury was observed in 4 (9.8%) of 41 patients with intra-abdominal injury, while 37 (90.2%) did not, and this was statistically significant (p = 0.003). The most common intra-abdominal organ injury was a small bowel injury in 23 (35.4%) patients. The coexistence of small bowel injury and large bowel injury was present in 8 patients (34.8%), and it was statistically significant (p = 0.019). A total of 14 (21.5%) of the patients died. There was no significant relationship between mortality and gender (p = 319). Brain damage was present in 10 (71.4%) of the 14 (21.5%) patients who died, which was statistically significant (p < 0.001). CONCLUSION Our results showed that the most common injuries were intra-abdominal injuries, damage to different organs could occur at the same time, and deaths were especially associated with brain injuries. For this reason, it should not be forgotten that CT scans will have an important place in the triage of the patient, especially in victims with shrapnel at the abdominal and cranial levels in radiography examinations.
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Affiliation(s)
- İnan Korkmaz
- Department of Radiology, Faculty of Medicine, Hatay Mustafa Kemal University, Alahan Kampüsü, Antakya, Hatay, Turkey.
| | - Mehmet Emin Çelikkaya
- Department of Pediatric Surgery, Faculty of Medicine, Hatay Mustafa Kemal University, Alahan Kampüsü, Antakya, Hatay, Turkey
| | - Ahmet Atıcı
- Department of Pediatric Surgery, Faculty of Medicine, Hatay Mustafa Kemal University, Alahan Kampüsü, Antakya, Hatay, Turkey
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Yammine K, Daher J, Otayek J, Jardaly A, Mansour J, Boulos K, Alam AE, Ghanimeh J, Abou Orm G, Berberi M, Daccache E, Helou M, Estephan M, Assi C, Hayek F. Beirut massive blast explosion: A unique injury pattern of the wounded population. Injury 2023; 54:448-452. [PMID: 36414502 DOI: 10.1016/j.injury.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 10/04/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION On August 4, 2020, a massive explosion of a warehouse holding 2,700 metric tons of ammonium nitrate took place in the port of Beirut, Lebanon. This incident, which is considered as one of the largest industrial disasters lead to the death of at least 220 people and more than 6000 injuries. Hospitals near the blast were damaged significantly which made it difficult to treat injured patients. The objective of this study is to report the epidemiology and characteristics of the injuries and their initial management that could be useful for healthcare workers and policymakers in case of a similar massive accident in the future. MATERIALS AND METHODS A retrospective study was conducted. All charts of patients admitted to the emergency room and outpatient clinics on the day of the blast and during the following 2 weeks were thoroughly reviewed. Due to initial chaos during triage, direct phone contact with patients was utilized in certain situations to confirm their identity or for further information. All acute injuries were recorded based on the region, severity, degree of emergency, initial and later management, type of injured organs, and surgical procedures. RESULTS A total of 159 patients presented to our facility. 153 patients presented to the ER on the same day of the blast. The mean age was 47.07 years and around 60% of the patients were males (n = 93). Most of the patients presented either from zone 1 (n = 67, 42%) or zone 3 (n = 68, 43%). The majority of injuries were secondary injuries due to glass (n = 131, 82.3%), with the head (34%) and upper extremities (31.2%) being most commonly affected. A total of 94 patients (62.6%) underwent a type of imaging and 64 patients (40.2%) had at least one surgery performed during their hospitalization in which 71% of the surgeries being related to the limbs. CONCLUSION This study demonstrated a unique injury pattern due to this type of blast. Injuries were mostly due to glass shrapnel. Contrary to bomb blasts, most injuries were located in the head and upper extremities rather than on the lower extremities.
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Affiliation(s)
- Kaissar Yammine
- Department of Orthopedic and Trauma Surgery, Lebanese American University Medical Center - Rizk Hospital, Lebanese American School of Medicine, Beirut, Lebanon.
| | - Jimmy Daher
- Department of Orthopedic and Trauma Surgery, Lebanese American University Medical Center - Rizk Hospital, Lebanese American School of Medicine, Beirut, Lebanon
| | - Joeffroy Otayek
- Department of Orthopedic and Trauma Surgery, Lebanese American University Medical Center - Rizk Hospital, Lebanese American School of Medicine, Beirut, Lebanon
| | - Achraf Jardaly
- Department of Orthopedic and Trauma Surgery, Lebanese American University Medical Center - Rizk Hospital, Lebanese American School of Medicine, Beirut, Lebanon
| | - Jad Mansour
- Department of Orthopedic and Trauma Surgery, Lebanese American University Medical Center - Rizk Hospital, Lebanese American School of Medicine, Beirut, Lebanon
| | - Karl Boulos
- Department of Orthopedic and Trauma Surgery, Lebanese American University Medical Center - Rizk Hospital, Lebanese American School of Medicine, Beirut, Lebanon
| | - Anthony El Alam
- Department of Orthopedic and Trauma Surgery, Lebanese American University Medical Center - Rizk Hospital, Lebanese American School of Medicine, Beirut, Lebanon
| | - Joe Ghanimeh
- Department of Orthopedic and Trauma Surgery, Lebanese American University Medical Center - Rizk Hospital, Lebanese American School of Medicine, Beirut, Lebanon
| | - Ghady Abou Orm
- Department of Orthopedic and Trauma Surgery, Lebanese American University Medical Center - Rizk Hospital, Lebanese American School of Medicine, Beirut, Lebanon
| | - Mary Berberi
- Department of Orthopedic and Trauma Surgery, Lebanese American University Medical Center - Rizk Hospital, Lebanese American School of Medicine, Beirut, Lebanon
| | - Elio Daccache
- Department of Orthopedic and Trauma Surgery, Lebanese American University Medical Center - Rizk Hospital, Lebanese American School of Medicine, Beirut, Lebanon
| | - Mariana Helou
- Department of Emergency Medicine, Lebanese American University Medical Center - Rizk Hospital, Lebanese American School of Medicine, Beirut, Lebanon
| | - Michel Estephan
- Department of Emergency Medicine, Lebanese American University Medical Center - Rizk Hospital, Lebanese American School of Medicine, Beirut, Lebanon
| | - Chahine Assi
- Department of Orthopedic and Trauma Surgery, Lebanese American University Medical Center - Rizk Hospital, Lebanese American School of Medicine, Beirut, Lebanon
| | - Fady Hayek
- Division of Vascular Surgery, Department of General Surgery, Lebanese American University Medical Center - Rizk Hospital, Lebanese American School of Medicine, Beirut, Lebanon
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Gamboa J, Horvath J, Simon A, Islam MS, Gao S, Perk D, Thoman A, Calderon DP. Secondary-blast injury in rodents produces cognitive sequelae and distinct motor recovery trajectories. Brain Res 2021; 1755:147275. [PMID: 33422537 DOI: 10.1016/j.brainres.2020.147275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/16/2020] [Accepted: 12/30/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Jasmine Gamboa
- Department of Anesthesiology, Weill Cornell Medical College, New York 10065, United States
| | - Jessica Horvath
- Department of Anesthesiology, Weill Cornell Medical College, New York 10065, United States
| | - Amanda Simon
- Department of Anesthesiology, Weill Cornell Medical College, New York 10065, United States
| | - Md Safiqul Islam
- Department of Anesthesiology, Weill Cornell Medical College, New York 10065, United States
| | - Sijia Gao
- Department of Anesthesiology, Weill Cornell Medical College, New York 10065, United States
| | - Dror Perk
- Department of Anesthesiology, Weill Cornell Medical College, New York 10065, United States
| | - Amy Thoman
- Department of Anesthesiology, Weill Cornell Medical College, New York 10065, United States
| | - Diany Paola Calderon
- Department of Anesthesiology, Weill Cornell Medical College, New York 10065, United States.
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Head and neck injuries after a bomb explosion: Diagnostic findings and treatment approaches. Am J Otolaryngol 2020; 41:102489. [PMID: 32340761 DOI: 10.1016/j.amjoto.2020.102489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To identify the types and severity of head, face and neck (HFN) injuries, which occurred as a result of a bomb explosion and reached serious life-threatening levels, using radiological imaging methods, and to discuss the options of treatment at the time of presentation. METHODS Of the 16 patients brought to the emergency department, 14 with HFN injuries were included in the study. Computed tomography (CT) and radiography scans were performed at the time of presentation in all patients, except for one. The injuries were divided into three groups according to their localization as head, face, and neck. RESULTS A subgaleal hematoma was seen in 10 of 11 (78.5%) patients with head injuries. Eight (57.1%) of nine patients with facial injury had fractures and/or ocular injury in the orbital wall, and seven (50%) patients had maxillofacial bone fractures. Among ocular trauma cases, open-globe injuries were detected in three patients (21.4%), closed-globe in two (14.2%), and both types in three (21.4%). Of the five (35.7%) patients with secondary blast injuries in the neck, three (21.4%) had laryngeal trauma (Zone 2) due to shrapnel, localized in the false vocal cord, epiglottis, and thyrohyoid membrane, respectively. Emergency surgery was performed on a patient with a specific laryngeal injury. CONCLUSION We consider that in patients presenting to the emergency department with blast HFN injuries, after providing airway patency and hemodynamic stability, CT and CT angiography should be performed because these modalities guide the treatment accurately and promptly.
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Ankara bombing: distribution of injury patterns with radiological imaging. Pol J Radiol 2020; 85:e90-e96. [PMID: 32467742 PMCID: PMC7247021 DOI: 10.5114/pjr.2020.93394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/07/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To describe and explain the blast injuries and imaging findings in the Ankara terrorist explosion that took place on October 10, 2015. Material and methods A total of 77 patients who underwent radiologic imaging were classified as primary, secondary, tertiary, and quaternary, according to the injury type. The patients were evaluated based on body regions, such as head and neck, thorax, abdomen, lower extremity, and upper extremity. Results Blast lung injury was identified in one patient and tympanic membrane perforation in seven patients, as the primary injury. Sixty-two of 77 patients had secondary blast injuries caused by shrapnel. The blast injuries were observed in the head and neck (16/77, 20.7%), thorax (11/77, 14.2%), abdomen (16/77, 20.7%), lower extremity (48/77, 62.3%), and upper extremity (5/77, 6.4%). Vascular injuries were seen in eight cases, of which seven were in the lower extremities. Conclusions The most common blast injury pattern was of a secondary type in the current study. Lower extremities were the significantly more affected body region, probably due to the bomb exploding at ground level. In mass casualty events, radiologic imaging is located at the centre of patient management.
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Soussy N, Dufayet L, Rey-Salmon C, Gorgiard C. The attack on November 13, 2015: organisation of the medico-judicial unit of the Hôtel-Dieu Hospital in Paris. Forensic Sci Res 2020; 5:232-235. [PMID: 33209507 PMCID: PMC7646567 DOI: 10.1080/20961790.2020.1768629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The main aims of a medico-judicial unit are to ensure the examination of assault victims or persons in custody and to perform sampling necessary for investigations. Forensic examination is essential to describe the wounds and to evaluate the consequences of an assault by determining days of total incapacity for work (ITT). After the Paris attack on November 13, 2015, 121 victims were examined at the medico-judicial units of Paris. An initial forensic certificate was issued by forensic physicians with an assessment of physical ITT. A consultation with a forensic psychiatrist was systematically scheduled on the same day to obtain a forensic certificate for the psychological ITT. The average age of the victims was (33 ± 7) years and the sex ratio was 1.26. Most victims were in the Bataclan concert hall (78/121 or 64.5%). Of the 121 victims, 73 (60.3%) had projectile lesions (bullets, bolts and nuts, metal fragments, etc.) and 48 (39.7%) had non-projectile lesions (bruises, hematomas, etc.). The average physical ITT was 27 days (0; 190). The evaluation of the number of days of physical ITT was often complicated as some patients were still in medical care at the time of the initial examination. This experience enabled the Paris medico-judicial unit to anticipate the management required should any future event of this magnitude occur. It also reinforced cooperation between the medico-judicial unit and other departments, mostly emergency services and the forensic psychiatric unit. The Paris medico-judicial unit was thus able to offer a unique place of care by providing both physical and psychological examinations.
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Affiliation(s)
- Nicolas Soussy
- Medico-Judicial Unit, Hôpital Hôtel-Dieu de Paris, APHP, Paris, France
| | - Laurène Dufayet
- Medico-Judicial Unit, Hôpital Hôtel-Dieu de Paris, APHP, Paris, France.,Centre AntiPoison et de Toxicovigilance, Hôpital Fernand Widal, APHP, Paris, France
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Grossman VA. Catastrophe in Radiology: Considerations Beyond Common Emergencies. JOURNAL OF RADIOLOGY NURSING 2020; 39:336-346. [PMID: 32406394 PMCID: PMC7218374 DOI: 10.1016/j.jradnu.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Disasters often occur without warning and have the potential to affect large numbers of people. Those in the radiology environment experience unique effects on them, their equipment, and their ability to provide quality patient care. Lessons can be learned by reviewing events and their impact on imaging departments around the world. Radiology departments need to be actively involved in the disaster planning and the management of disasters when they occur. Common themes emerge regardless of the type of disaster, and these themes should be included in all planning.
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Affiliation(s)
- Valerie Aarne Grossman
- Highland Hospital, University of Rochester, Nurse Manager of Medical Imaging, Rochester, NY
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Imaging Patterns of Injuries After the 2015 Amtrak Philadelphia Train Derailment. AJR Am J Roentgenol 2018; 210:948-961. [PMID: 29489405 DOI: 10.2214/ajr.17.18832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to describe the injury patterns observed in the 2015 Philadelphia Amtrak train derailment. CONCLUSION Fractures accounted for most observed injuries, but uncommon and potentially serious injuries included posterior sternoclavicular dislocation and mesenteric contusion. Imaging plays a critical role in the triage of patients during mass-casualty events, and familiarity with the injury patterns associated with high-velocity unrestrained blunt force trauma will aid diagnosis in any future similar occurrence.
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Jahangiri K, Ghodsi H, Khodadadizadeh A, Yousef Nezhad S. Pattern and nature of Neyshabur train explosion blast injuries. World J Emerg Surg 2018; 13:3. [PMID: 29387143 PMCID: PMC5775571 DOI: 10.1186/s13017-018-0164-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/11/2018] [Indexed: 11/10/2022] Open
Abstract
Background Explosions are classified as both man-made and complex accidents. Explosive events can cause serious damage to people, property, and the environment. This study aimed to investigate the pattern and nature of damage incurred to the victims of the Neyshabur Train Explosion. Methods The current study is a descriptive cross-sectional study that was retrospectively performed on 99 individuals using census method and documents victims hospitalized due to the Neyshabur train disaster (February 2004) in 2016. In this study, different variables such as age, sex, type of injury, treatment, etc. were examined using a questionnaire and were analyzed using SPSS16. Results The results showed that 50.5% of victims were males with mean age of 30.33 ± 4.27 years and most of them were in 20- to 40-year age group. A total of 98 victims were discharged after treatment, and 1 victim died due to the severity of injuries after 3 days of hospitalization. Second type of injuries caused by the explosion accounted for most of the injuries (55.6%), and most treatments (54.5%) were related to the specific field of orthopedics. Conclusion Handling and transportation of fuels and chemicals via rail transport system is one of the potential hazards that threatens human life. The results showed that the highest numbers of victims were in 20- to 40-year age group, which is the age of economic efficiency. The prevention and reduction of human and financial losses resulting from accidents require proper national planning.
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Affiliation(s)
- Katayoun Jahangiri
- Department of Health in Disasters and Emergencies, School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hasan Ghodsi
- Department of Health in Disasters and Emergencies, School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Khodadadizadeh
- Department of Health in Disasters and Emergencies, School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sadegh Yousef Nezhad
- Department of Health in Disasters and Emergencies, School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kuckelman J, Cuadrado D, Martin M. Thoracic Trauma: a Combat and Military Perspective. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0112-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Singh AK, Ditkofsky NG, York JD, Abujudeh HH, Avery LA, Brunner JF, Sodickson AD, Lev MH. Blast Injuries: From Improvised Explosive Device Blasts to the Boston Marathon Bombing. Radiographics 2016; 36:295-307. [PMID: 26761543 DOI: 10.1148/rg.2016150114] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although most trauma centers have experience with the imaging and management of gunshot wounds, in most regions blast wounds such as the ones encountered in terrorist attacks with the use of improvised explosive devices (IEDs) are infrequently encountered outside the battlefield. As global terrorism becomes a greater concern, it is important that radiologists, particularly those working in urban trauma centers, be aware of the mechanisms of injury and the spectrum of primary, secondary, tertiary, and quaternary blast injury patterns. Primary blast injuries are caused by barotrauma from the initial increased pressure of the explosive detonation and the rarefaction of the atmosphere immediately afterward. Secondary blast injuries are caused by debris carried by the blast wind and most often result in penetrating trauma from small shrapnel. Tertiary blast injuries are caused by the physical displacement of the victim and the wide variety of blunt or penetrating trauma sustained as a result of the patient impacting immovable objects such as surrounding cars, walls, or fences. Quaternary blast injuries include all other injuries, such as burns, crush injuries, and inhalational injuries. Radiography is considered the initial imaging modality for assessment of shrapnel and fractures. Computed tomography is the optimal test to assess penetrating chest, abdominal, and head trauma. The mechanism of blast injuries and the imaging experience of the victims of the Boston Marathon bombing are detailed, as well as musculoskeletal, neurologic, gastrointestinal, and pulmonary injury patterns from blast injuries.
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Affiliation(s)
- Ajay K Singh
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND-210, Boston, MA 02114 (A.K.S., H.H.A., L.A.A., M.H.L.); Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (N.G.D.); Department of Radiology, Naval Medical Center, Portsmouth, Va (J.D.Y.); Department of Radiology, University of Southern California, Los Angeles, Calif (J.F.B.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.D.S.)
| | - Noah G Ditkofsky
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND-210, Boston, MA 02114 (A.K.S., H.H.A., L.A.A., M.H.L.); Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (N.G.D.); Department of Radiology, Naval Medical Center, Portsmouth, Va (J.D.Y.); Department of Radiology, University of Southern California, Los Angeles, Calif (J.F.B.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.D.S.)
| | - John D York
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND-210, Boston, MA 02114 (A.K.S., H.H.A., L.A.A., M.H.L.); Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (N.G.D.); Department of Radiology, Naval Medical Center, Portsmouth, Va (J.D.Y.); Department of Radiology, University of Southern California, Los Angeles, Calif (J.F.B.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.D.S.)
| | - Hani H Abujudeh
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND-210, Boston, MA 02114 (A.K.S., H.H.A., L.A.A., M.H.L.); Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (N.G.D.); Department of Radiology, Naval Medical Center, Portsmouth, Va (J.D.Y.); Department of Radiology, University of Southern California, Los Angeles, Calif (J.F.B.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.D.S.)
| | - Laura A Avery
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND-210, Boston, MA 02114 (A.K.S., H.H.A., L.A.A., M.H.L.); Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (N.G.D.); Department of Radiology, Naval Medical Center, Portsmouth, Va (J.D.Y.); Department of Radiology, University of Southern California, Los Angeles, Calif (J.F.B.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.D.S.)
| | - John F Brunner
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND-210, Boston, MA 02114 (A.K.S., H.H.A., L.A.A., M.H.L.); Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (N.G.D.); Department of Radiology, Naval Medical Center, Portsmouth, Va (J.D.Y.); Department of Radiology, University of Southern California, Los Angeles, Calif (J.F.B.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.D.S.)
| | - Aaron D Sodickson
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND-210, Boston, MA 02114 (A.K.S., H.H.A., L.A.A., M.H.L.); Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (N.G.D.); Department of Radiology, Naval Medical Center, Portsmouth, Va (J.D.Y.); Department of Radiology, University of Southern California, Los Angeles, Calif (J.F.B.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.D.S.)
| | - Michael H Lev
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND-210, Boston, MA 02114 (A.K.S., H.H.A., L.A.A., M.H.L.); Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (N.G.D.); Department of Radiology, Naval Medical Center, Portsmouth, Va (J.D.Y.); Department of Radiology, University of Southern California, Los Angeles, Calif (J.F.B.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.D.S.)
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14
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Yu M, Lv Q, Ding H, Zeng X, Cao J, Liu J, Fan H, Hou S. Evaluation of blast injury patients from the 2015 Tianjin explosions in China. Burns 2016; 42:1133-1140. [PMID: 27311537 DOI: 10.1016/j.burns.2016.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/23/2016] [Accepted: 03/13/2016] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Mengyang Yu
- Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistic University of the Chinese People's Armed Police Force (PAP), Tianjin, China
| | - Qi Lv
- Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistic University of the Chinese People's Armed Police Force (PAP), Tianjin, China
| | - Hui Ding
- Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistic University of the Chinese People's Armed Police Force (PAP), Tianjin, China
| | - Xihuan Zeng
- Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistic University of the Chinese People's Armed Police Force (PAP), Tianjin, China
| | - Juan Cao
- Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistic University of the Chinese People's Armed Police Force (PAP), Tianjin, China
| | - Jinyang Liu
- Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistic University of the Chinese People's Armed Police Force (PAP), Tianjin, China
| | - Haojun Fan
- Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistic University of the Chinese People's Armed Police Force (PAP), Tianjin, China.
| | - Shike Hou
- Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistic University of the Chinese People's Armed Police Force (PAP), Tianjin, China.
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15
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Konwinski RR, Singh A, Soto J. Imaging of lower extremity trauma from Boston Marathon bombing. Emerg Radiol 2016; 23:433-7. [PMID: 27272899 DOI: 10.1007/s10140-016-1414-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
Abstract
The goal of this study is to describe the imaging features of lower extremity blast injuries in patients encountered in the radiology departments from the Boston Marathon bombings. A total of 115 patients presented to four acute care hospitals on April 15, 2013, 43 of whom presented with lower extremity injuries and were included in this study. The imaging findings of primary, secondary, tertiary, and quaternary blast injuries were evaluated. Forty-one of 43 patients sustained secondary blast injuries to the lower extremities with 31 patients (70 %) having retained shrapnel, seven patients (16 %) having soft tissue lacerations without retained shrapnel, and ten patients (23 %) having lower extremity amputation (7 % double amputees). Eight of these patients (20 %) had lower extremity fractures, and five patients (12 %) had vascular injuries. Two of the 43 patients (5 %) had only tertiary injuries, and five of 43 patients (12 %) were noted to have lower extremity burns, consistent with quaternary blast injury. No primary blast injury occurred in the lower extremities. A vast majority of lower extremity injuries were from secondary blast injury, most commonly from retained shrapnel in 70 % of patients and 23 % of patients sustaining lower extremity amputation. Retained shrapnel in the lower extremity was most commonly ball bearings and pressure cooker fragments, and most injuries affected the leg, followed by the thigh and foot.
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Affiliation(s)
- Ryan R Konwinski
- Division of Emergency Radiology, Department of Radiology, Massachusetts General Hospital, 2 Avery Street, 32H, Boston, MA, 02141, USA
| | - Ajay Singh
- Division of Emergency Radiology, Department of Radiology, Massachusetts General Hospital, 2 Avery Street, 32H, Boston, MA, 02141, USA.
| | - Jorge Soto
- Department of Radiology, Boston Medical Center, Boston, MA, 02118, USA
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16
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Yazgan C, Aksu NM. Imaging features of blast injuries: experience from 2015 Ankara bombing in Turkey. Br J Radiol 2016; 89:20160063. [PMID: 26959613 DOI: 10.1259/bjr.20160063] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To present the radiological features of blast-related injuries in the victims of the 10 October 2015 Ankara bombing and emphasize the importance of imaging. METHODS This retrospective descriptive study included a total of 28 patients who underwent CT scan or radiographic imaging within 6 h after the bombing on 10 October 2015. CT scans and plain radiographs were evaluated regarding mechanisms of injuries. Injuries were categorized as primary, secondary, tertiary and quaternary. The number of shrapnel and distribution of injuries were noted. Injury Severity Score (ISS) was used to rank the severity of the injury. RESULTS Primary blast injuries consisted of only tympanic membrane rupture. A high rate of patients (21/28 patients) in the study group suffered from secondary blast injuries. Tertiary injuries were detected in only three patients. Of the severely injured patients, five had abdominal injuries, three had thoracic injuries and six had extremity injuries. ISS was significantly higher in patients with thoracic and abdominal injuries. CONCLUSION Our results after the suicide bomb attacks showed that the most common injury pattern was secondary blast injury. The torso was the most commonly injured body region, followed by the extremities. This specific injury pattern requires the use of immense radiological imaging. Hence, radiologists should be aware of the mechanisms and spectrums of blast-related injuries. ADVANCES IN KNOWLEDGE Both the unique injury pattern and the following chaos make blast-related injuries a challenge in terms of triage, diagnosis and management. Radiologists should be familiar with the wide spectrum of these unique injuries.
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Affiliation(s)
- Cisel Yazgan
- 1 Department of Radiology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Nalan M Aksu
- 2 Department of Emergency Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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17
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Singh AK, Sodickson A, Abujudeh H. Imaging of abdominal and pelvic injuries from the Boston Marathon bombing. Emerg Radiol 2015; 23:35-39. [DOI: 10.1007/s10140-015-1354-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/30/2015] [Indexed: 10/23/2022]
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18
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Mathews ZR, Koyfman A. Blast Injuries. J Emerg Med 2015; 49:573-87. [PMID: 26072319 DOI: 10.1016/j.jemermed.2015.03.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 01/04/2015] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Zara R Mathews
- Department of Emergency Medicine, Mount Sinai Medical Center, New York, New York
| | - Alex Koyfman
- Division of Emergency Medicine, University of Texas Southwestern Medical Center/Parkland Memorial Hospital, Dallas, Texas
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19
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Head and neck injuries from the Boston Marathon bombing at four hospitals. Emerg Radiol 2015; 22:527-32. [DOI: 10.1007/s10140-015-1322-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
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20
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Brunner J, Singh AK, Rocha T, Havens J, Goralnick E, Sodickson A. Terrorist Bombings: Foreign Bodies from the Boston Marathon Bombing. Semin Ultrasound CT MR 2015; 36:68-72. [DOI: 10.1053/j.sult.2014.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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