muhammad abdullah blast inj
TRANSCRIPT
Blast injuryPresented ByPresented By
MUHAMMAD ABDULLAHMUHAMMAD ABDULLAH
Blast injury
Rapid chemical conversion of a solid or liquid into a gas with resultant energy release.
All nuclear explosion provide this All nuclear explosion provide this change in potential energy to kinetic change in potential energy to kinetic injury in a very short period of time.injury in a very short period of time.
Once notified of a possible Once notified of a possible bombing or explosion, hospital-bombing or explosion, hospital-based physicians should consider based physicians should consider immediately activating hospital immediately activating hospital disaster plans, including disaster plans, including preparations to care for anywhere preparations to care for anywhere from a handful to hundreds of from a handful to hundreds of victims. victims.
Blast injury Blast injuries in civilian populations occur as a Blast injuries in civilian populations occur as a
result of result of fireworks, fireworks, household explosions, or household explosions, or industrial accidents. industrial accidents. Terrorist tactics may take the form of Terrorist tactics may take the form of letter bombs, letter bombs, suitcase bombs, suitcase bombs, vehicle bombs, and vehicle bombs, and suicide bombers.suicide bombers.
BackgroundBackground Explosions have the capability to cause Explosions have the capability to cause
multisystem, life-threatening injuries in multisystem, life-threatening injuries in single or multiple victims simultaneously.single or multiple victims simultaneously.
Explosions can produce classic injury Explosions can produce classic injury patterns from blunt and penetrating patterns from blunt and penetrating mechanisms to several organ systems, but mechanisms to several organ systems, but they can also result in unique injury they can also result in unique injury patterns to specific organs including the patterns to specific organs including the lungs and the central nervous system lungs and the central nervous system
CategoryCategoryCharacteristicsCharacteristicsBody Part AffectedBody Part AffectedTypes of InjuriesTypes of InjuriesPrimaryPrimaryResults from the impact Results from the impact
of the over-of the over-pressurization wave with pressurization wave with body surfaces. body surfaces.
Gas filled structures Gas filled structures lungs, GI tract, and lungs, GI tract, and middle ear.middle ear.Blast lung injuryBlast lung injury
TM ruptureTM rupture and middle and middle ear damage ear damage Abdominal hemorrhage Abdominal hemorrhage and perforation and perforation Concussion Concussion (TBI)(TBI)
SecondarySecondaryResults from flying Results from flying debris and bomb debris and bomb fragments. Shells fragments. Shells
Any body part may Any body part may be affected.be affected.
Penetrating blunt Penetrating blunt injuries injuries Eye penetrationEye penetration
TertiaryTertiaryResults from individuals Results from individuals being thrown by the being thrown by the blast wind.blast wind.
Any body part may Any body part may be affected.be affected.
Fracture and traumatic Fracture and traumatic amputation amputation Closed and open brain Closed and open brain injuryinjury
Quaternary Quaternary All explosion-related All explosion-related injuries, illnesses, or injuries, illnesses, or diseases not due to diseases not due to primary, secondary, or primary, secondary, or tertiary mechanisms. tertiary mechanisms.
Any body part may Any body part may be affected.be affected.
Burns Burns Crush injuriesCrush injuriesClosed and open brain Closed and open brain injuryinjurybreathing problems breathing problems from dust, smoke, or from dust, smoke, or toxic fumestoxic fumes
Overview of Explosive-Related InjuriesSystemSystemInjury or ConditionInjury or Condition
AuditoryAuditoryTM rupture, ossicular disruption, cochlear damage, foreign TM rupture, ossicular disruption, cochlear damage, foreign bodybody
Eye, Orbit, FaceEye, Orbit, FacePerforated globe, foreign body, fracturesPerforated globe, foreign body, fracturesRespiratoryRespiratoryBlast lung, hemothorax, pneumothorax, pulmonary Blast lung, hemothorax, pneumothorax, pulmonary
contusion and hemorrhage. contusion and hemorrhage.
DigestiveDigestiveBowel perforation, hemorrhage, ruptured liver or spleen,, Bowel perforation, hemorrhage, ruptured liver or spleen,, mesenteric ischemia from air embolismmesenteric ischemia from air embolism
CirculatoryCirculatoryCardiac contusion, myocardial infarction from air embolism, Cardiac contusion, myocardial infarction from air embolism, shock,, peripheral vascular injury, shock,, peripheral vascular injury,
CNS InjuryCNS InjuryConcussion, closed and open brain injury, spinal cord Concussion, closed and open brain injury, spinal cord injury, injury,
Renal InjuryRenal InjuryRenal contusion, laceration, acute renal failure due to Renal contusion, laceration, acute renal failure due to hypotension, and hypovolemiahypotension, and hypovolemia
Extremity InjuryExtremity InjuryTraumatic amputation, fractures, crush injuries, Traumatic amputation, fractures, crush injuries,
PBI---------EAR
Tympanic membrane ruptured from overpressure of 1 – 8 psi.
The first organ to sustain damage is typically the ear.
INITIAL MANAGEMENTINITIAL MANAGEMENT
Manage as other soft tissue injuries Manage as other soft tissue injuries Attention to foreign body removal, Attention to foreign body removal, cleaning of wounds, and closurecleaning of wounds, and closure. .
Cartilage must not be left exposed and Cartilage must not be left exposed and wounds should be closed primarilywounds should be closed primarily; ; The patient should be referred to The patient should be referred to
SpecialistSpecialist . .
Blast Lung InjuryBlast Lung InjuryMajor cause of death in PBI’s
Clinical PresentationClinical Presentation • •Symptoms may include dyspnea, Symptoms may include dyspnea,
hemoptysis, cough, and chest painhemoptysis, cough, and chest pain . . • •Signs may include tachypnea, hypoxia Signs may include tachypnea, hypoxia
cyanosis, apnea, wheezing, decreased cyanosis, apnea, wheezing, decreased breath sounds, and hemodynamic breath sounds, and hemodynamic
instabilityinstability . . • •Other injuries may be presentOther injuries may be present . .
Chest X-ray of a victim of
bombing attack showing typical
bilateral patchy infiltrates in a butterfly distribution.
BLI’s ManagementBLI’s Management Diagnostic Evaluation • Chest radiography is necessary for anyone
who is exposed to a blast. A characteristic “butterfly” pattern may be
revealed upon x-ray. • Arterial blood gases, computerized
tomography, and doppler technology may be used. • Most laboratory and diagnostic testing can
be conducted
““Blast Lung”Blast Lung”White Butterfly SignWhite Butterfly Sign
Tension PneumothoraxTension Pneumothorax
Treatment of BLI
Patients with suspected or confirmed BLI should receive Patients with suspected or confirmed BLI should receive supplemental high-flow oxygen to prevent hypoxemiasupplemental high-flow oxygen to prevent hypoxemia
If ventilatory failure occurs, patients should be intubatedIf ventilatory failure occurs, patients should be intubated . .
High-flow oxygen should be administered if air embolism is High-flow oxygen should be administered if air embolism is suspected, and the patient should be placed in a prone, suspected, and the patient should be placed in a prone,
semi-left lateral, or left lateral positionsemi-left lateral, or left lateral position
PBI - AbdomenPBI - AbdomenHemorrhage :
Hematoma leading to obstruction
Upper or lower GI bleeding Hemoperitoneum
Escape of Contents :Mediastinitis Peritonitis
Mesenteric, retroperitoneal, and scrotal hemorrhages.
Abdominal InjuriesAbdominal Injuries
Management of Abd.InjManagement of Abd.InjInitial ManagementInitial Management
• •ABCs (airway, breathing, circulation) as for all trauma ABCs (airway, breathing, circulation) as for all trauma patientspatients
• •Nothing by mouthNothing by mouth • •Avoid removal of penetrating objects in emergency Avoid removal of penetrating objects in emergency
room (operative intervention due to risk of hemorrhage)room (operative intervention due to risk of hemorrhage) • •Antibiotics and tetanus immunizationAntibiotics and tetanus immunization
• •Serial exams and laboratory monitoringSerial exams and laboratory monitoring • •Radiological studies: plain abdominal films, computed Radiological studies: plain abdominal films, computed
tomography [CT] scan, Focused Abdominaltomography [CT] scan, Focused AbdominalSonography for Trauma (FASTSonography for Trauma (FAST
– Injuries from devices that contain foreign bodies:• NailsNails• Rivets Rivets • Ball bearingsBall bearings• Nuts and bolts,Nuts and bolts,• ShellsShells
Secondary InjuriesSecondary Injuries
Injuries - PenetratingInjuries - Penetrating
Tertiary injuriesTertiary injuries – Physically thrown through the air and strike
or impale themselves on objects.– Collapsing structures.– Other objects propelled through the air
striking the victim.Severe head injury is a leading cause of
death in victims of blasts.Subdural and subarachnoid hemorrhages
are the most common findings
Quaternary InjuriesQuaternary Injuries Thermal injuries Primary or secondary
incendiary. – Inhalation– Dermal• Flash Burns • Large body
surface area• Shallow
depth
Management Of Burn PTManagement Of Burn PT.. Early treatment of partial thickness burn wound consists of mechanical debridement with wet gauzes.
Burns involving small BSA are treated with topical antimicrobial agents, while larger areas are treated with
homografts. Homografts cover the wounds for 10–14 days and provide protection from desiccation and infection.
PhysicalPhysical Headaches Headaches Dizziness Dizziness Insomnia Insomnia Fatigue Fatigue Uneven gait Uneven gait Nausea Nausea Blurred Vision Blurred Vision CognitiveCognitive Attention difficulties Attention difficulties Concentration problems Concentration problems Memory problems Memory problems Orientation problems Orientation problems
Signs and Symptoms of a Traumatic Brain Injury (TBI)Signs and Symptoms of a Traumatic Brain Injury (TBI)
Behavioral Irritability Depression Anxiety Sleep disturbances Problems with emotional control Loss of initiative Problems related to employment, marriage, relationships, and home or school management
Blast Extremity InjuriesBlast Extremity Injuries
Traumatic amputationTraumatic amputation Initial ManagementInitial Management
• •Even when blast victims have small entrance wounds, Even when blast victims have small entrance wounds, surgeons should maintain a low threshold for performing surgeons should maintain a low threshold for performing thorough debridementthorough debridement
• •All open fractures are considered contaminated and should All open fractures are considered contaminated and should receive early antibiotic treatment (first generation receive early antibiotic treatment (first generation cephalosporin and/or aminoglycoside, extended spectrum cephalosporin and/or aminoglycoside, extended spectrum penicillin)penicillin)
• •Obviously contaminated wounds should be irrigated with Obviously contaminated wounds should be irrigated with sterile saline and dressed with iodophore (Betadine)- soaked sterile saline and dressed with iodophore (Betadine)- soaked sponges; once dressed, re-exposure should wait until sponges; once dressed, re-exposure should wait until operative explorationoperative exploration
• •Tetanus prophylaxis should be administered unless Tetanus prophylaxis should be administered unless immunization within five years can be documentedimmunization within five years can be documented
• •Extremity fractures should be splinted to Extremity fractures should be splinted to provide mechanical stability and relieve provide mechanical stability and relieve painpain. .
Eye Injuries……Blast eye injuries may present with a wide range of symptoms, from minimal discomfort to severe pain or loss of vision.
Minor blast-related eye injuries include corneal abrasions, conjunctivitis.
Eyelid lacerations, penetrating and perforating injuries to the cornea or sclera
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