0071643192.pdf

EMS AND DISASTER MEDICINE

TREATMENT

■ Immediate decontamination, as needed:
■ Remove clothing (will remove the majority of contamination), wash skin.
■ Enhance elimination of ingested particles (cathartics, lavage etc).
■ Blocking agents: eg, potassium iodine for radioactive iodine exposure
■ Chelating agents: eg, calcium disodium edetate and penicillamine for
radioactive lead exposure
■ Supportive care
■ The absolute lymphocyte count at 48 hours is the best predictor of survival
(see Table 20.12).

COMPLICATIONS

■ Delayed malignancy
■ Mutagenesis in offspring

BLAST INJURIES

Primary Blast Injury

■ Barotrauma resulting from the blast pressure wave
■ Air-containing structure is most commonly affected (ears, lung, intestines).

Secondary Blast Injury

■ Results from solid projectiles from the explosive itself or the surrounding
structures

Tertiary Blast Injury

■ Seen when victim is thrown against a solid structure or caught in a struc-
tural collapse
■ Most lethal injury

Most common blast injury =tympanic membrane (TM) rupture at the pars
tensa. This predicts other significant injury.

SYMPTOMS/EXAM

■ Depends on organs involved and presence of secondary or tertiary injuries

Primary Blast Injury

■ Ear involvement: Hearing loss, vertigo, nystagmus, and TM rupture
■ Pulmonary

TABLE 20.12. Predicting Survival After Radiation Injury

ABSOLUTELYMPHOCYTES

PROGNOSIS (AT48 HOURS)

Good >1200/mm^3

Fair 300–1200/mm^3

Poor <300/mm^3

Primary last injury =blast

pressure wave.

Secondary blast injury =

projectiles from the explosion.

Tertiary blast injury =blunt

trauma from explosion.

TM rupture predicts other

significant injury.

The absolute lymphocyte

count at 48 hours can be used

to predict survival.