0071643192.pdf

EMS AND DISASTER MEDICINE^916

■ Barotrauma (pneumothorax, air embolism, pneumomediastinum)

■ Pulmonary hemorrhage: Increasing respiratory distress and poor air

exchange

■ Intestinal

■ Less common than ear or lung injury

■ Intestinal wall hemorrhage and edema →abdominal pain, N/V.

Secondary and Tertiary Blast Injury

■ Findings of penetrating injuries, boney fractures/dislocations, closed head

injuries

■ If suicide bomber, possible human foreign material embedded

DIAGNOSIS

■ Standard trauma evaluation

■ Careful evaluation to rule out primary blast injury:

■ CXR in all cases

■ Chest CT if significant pulmonary symptoms

■ Abdominal CT if any GI symptoms

TREATMENT

■ Supportive care

■ Treat associated injuries.

■ Risk of pneumothorax and air embolism is particularly high in blast lung

injury.

■ Minimize peak airway pressures and allow permissive hypercapnea in

ventilated patient.

■ Immediate hyperbarics if suspected air embolism

■ Consider Hepatitis B vaccine and IgG if suicide bomber.

Following blast injury, obtain

abdominal CT if any GI

symptoms are present.