Primary Blast Injury (PBI)
General Management
Respiratory System
Arterial Air Emboli
G.I. System
Auditory System
General Management
1.
Initiate life support
2.
Hx: distance from explosion, underwater or in enclosure
3.
PE: ruptured tympanic membrane; retinal air emboli; SQ emphysema; ecchymoses
4.
CBC, CXR, CT chest, abdomen, head if H&P suggests pathology
5.
Limit physical activity
6.
Air evacuation: risks include cabin pressure, oxygenation worse at altitude
7.
Most life-threatening is damage to air containing organs
Respiratory System
1.
At most risk after tympanic membrane
2.
Dyspnea, CP, cough, hemoptysis
3.
PE: tachypnea, cyanosis, dullness to percussion, decr’d breath sounds, crepitus
4.
Pulmonary contusion invariably present:
Hemorrhage & eosinophilic edema in alveolar spaces
Respiratory insufficiency depends on degree of hemorrhage
5.
Parenchymal laceration: hemothorax
6.
Barotrauma: tearing of alveolar septae – pneumothorax, air embolism, SQ emphysema
7.
Treatment:
O2, non-invasive ventilation; be aware of tension pneumo
Mechanical ventilation may cause arterial air emboli
8.
Circulatory support: hypotension due to blood loss, GI hemorrhage, air emboli
Arterial Air Emboli
1.
Blindness, focal neuro deficit
2.
Chest pain, LOC
3.
PE: air in retinal vessels, focal neuro deficits, tongue blanching
4.
Give supplemental O2, pt in left lateral decubitus position
5.
Consider mechanical ventilation, hyperbaric therapy
G.I. System
1.
Overshadowed by life-threatening pulmonary PBI
2.
Edema, hemorrhage, organ rupture:
Gas containing organs more affected
Damage to solid organs from secondary or tertiary blast injury
3.
Pain, N/V/D
4.
PE: absent BS, guarding, rebound tenderness
5.
Hemodynamically unstable: resuscitate & peritoneal lavage, then laparotomy
6.
Hemodynamically stable: CT with IV contrast
7.
Do CT before lavage or get false positive lavage
8.
CT negative & signs of peritoneal injury:
Peritoneal lavage
If non clotting blood >10cc – exploratory laparotomy
9.
Exploratory laparotomy in hemoperitoneum, hematoma, extraluminal contrast, organ injury; get CXR first
10.
Abdominal complaints with negative CT and lavage: monitor closely to R/O abscess
Auditory System
1.
Damage to middle & inner ear
2.
Tympanic membrane rupture, hearing loss, tinnitus, vertigo
3.
No specific therapy for acoustic trauma
4.
Tympanic rupture: remove debris, irrigate canal
5.
Perform primary closure if >1/3 of membrane damaged
* Material is taken from the PEPID database
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