Related to this topic: Equipment | Books | Your Experience | Other resources | Glossaries
Print options:
Other options:
(what's this?)
PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.
Blast Injury
Although terrorism is an ever increasing concern, most blast injuries are caused by accidents such as gas explosions. The management will often involve implementation of the local major incident plan.
Blast injuries are divided into 4 categories:
- A primary blast injury is caused by the direct effect of blast overpressure on tissue. The injury almost always affects air-filled structures such as the lung, ear, and gastrointestinal tract1
- A secondary blast injury is caused by people being hit by flying objects
- A tertiary blast injury is caused by high-energy explosions and occurs when people fly through the air and strike other objects
- Miscellaneous blast-related injuries include all other injuries caused by explosions, e.g. due to fire or collapse of buildings
Frequency depends on both the political stability of the region, e.g. terrorism, and local factors such as occupational health and safety priorities.
- Lungs may show evidence of pulmonary trauma and pneumothorax. Wheezing may be due to pulmonary contusion, inhalation of irritant gasses or dusts, pulmonary oedema or adult respiratory distress syndrome (ARDS).
- Rupture of tympanic membrane may but not always indicate additional more serious injury2
- Abdominal injuries from explosions may not be immediately obvious and serial examinations are often required. Intestinal haematoma can take 12-36 hours to develop.
All investigations will be carried out by the within the emergency department but the following is a basic guide:
- Screening urinalysis to detect injury to the renal tract
- If the explosion occurred in an enclosed space or was accompanied by fire, test carboxyhaemoglobin (carbon monoxide poisoning) and electrolytes to assess acid-base status
- For major trauma, baseline haemoglobin, crossmatch and screen for disseminated intravascular coagulation
- If significant crush injury, compartment syndrome, or severe burns, rhabdomyolysis may cause hyperkalaemia and myoglobinuric renal failure
- Burns from military white phosphorous munitions may cause hypocalcaemia and hyperphosphataemia. White phosphorus is a widely used component of military munitions, including hand grenades.
- Chest x-ray for all those who have been exposed to high-pressure injury
- If significant abdominal pain, abdominal x-ray (erect and supine) or abdominal CT to detect pneumoperitoneum from bowel rupture
- If there is any question of radiation or chemical contamination, decontamination of patients and equipment will be required
- There will inevitably be huge emotional as well as physical stress. Psychological help will be required from the outset and a calm, organised, supportive and caring approach to management of people involved in the accident is essential.
Drugs
- Life support, including intravenous fluids and blood transfusions may well be required at the site of the accident
- Specific treatments may also need to be considered
- Cyanide poisoning:
- Consider cyanide poisoning in patients exposed to combustion in an enclosed space
- Cyanide is produced by incomplete combustion of plastics
- Treatment for cyanide poisoning should be started for significantly ill patients while awaiting confirmatory test results
- Sodium thiosulfate and hydroxocobalamin are safe and appropriate empirical therapy
- Mortality rates vary widely
- Mortality is increased when explosions occur in closed or confined spaces3
- Tympanic membrane rupture indicates that a high-pressure wave was present and may be associated with more severe organ injury
Document references
- Argyros GJ; Management of primary blast injury.; Toxicology. 1997 Jul 25;121(1):105-15. [abstract]
- Leibovici D, Gofrit ON, Shapira SC; Eardrum perforation in explosion survivors: is it a marker of pulmonary blast injury?; Ann Emerg Med. 1999 Aug;34(2):168-72. [abstract]
- Leibovici D, Gofrit ON, Stein M, et al; Blast injuries: bus versus open-air bombings--a comparative study of injuries in survivors of open-air versus confined-space explosions.; J Trauma. 1996 Dec;41(6):1030-5. [abstract]
Internet and further reading
- Lavonas E; Blast Injuries. Emedicine; January 2006.
- Trauma.org (independent, non-profit organisation providing global education, information and communication resources for professionals in trauma and critical care).
DocID: 1871
Document Version: 21
DocRef: bgp1881
Last Updated: 10 Jan 2007
Review Date: 9 Jan 2009
Disclaimer: Patient UK has no control of the content of the above links. Inclusion does not imply endorsement by Patient UK.
Related pages in Patient UK
Your Experience (^ top of page)
Please add your experience about this condition / medicineOther - Useful resources (^ top of page)
Pictures, diagrams, photos, images, etc.Evidence based medicine
Online textbooks and journals
A-Z of UK Guidelines
A-Z of Online Videos
Medline
Other good health sites
Medical equipment products related to this topic (^ top of page)

Books related to this topic (^ top of page)

Want to search some more? Use the Google Search box below to search our site.

Would you like to try our advanced on-line knowledge support system designed to provide professionals with relevant up to date information about recognition and management of disease or take the Mentor Challenge?
Disclaimer: Patient UK has no control of the content of the above links. Inclusion does not imply endorsement by Patient UK.
