Section: Trauma Curriculum: Curriculum, page 77
Definition
Pressure waves generated by explosion causing trauma
Classification
- Explosion pressure, Fragment projectile, Landing trauma, other
- Primary
- Due to Direct Pressure or Barotrauma
- At risk organs are gas filled
- Lung | bowel | tympanic membrane
- Secondary
- Fragmentation injury
- Blast projectiles or penetrating trauma
- Tertiary
- Displacement Injury
- Persons or objects being thrown
- Cause acceleration/deceleration injuries/soft tissue destruction
- Quaternary
- Due to injuries from events during trauma
- Flash burns | crush injuries | respiratory injuries
- Quinary
- Injury causes by exposure to toxins from blast
- E.g. Ionizing radiation
What is it and how does it cause injury?
- Blast injury = Physiological and physical injury caused by explosion
- Shock wave from explosion = Blast wave
- Blast wave leading edge = Blast front
- Rush of air caused by blast wave = Blast wind
- In a closed space, blast wave magnifies by reflecting off walls and ceilings
Abdominal Blast Injury
- Least common c.f. Others
- More common if enclosed space
- MURAL HAEMATOMAS
- Range of presentation
- Minor to perforation
- Range of presentation
- Shearing injury
Blast lung
- Essentially pulmonary contusion but may be without fracture
- Rupture of alveoli
- Blood influx: Alveolar haemorrhage, release of cytokines and chemokines
- OR Air efflux: Air embolism
- Desaturation
- Butterfly X-Ray pattern - Bihilar shadowing
- Supportive management - ICU, mechanical ventilation, low pressure to avoid barotrauma, chest physio, DBE, nebulisers?