Blast Trauma

Explosions occur due to a rapid release of chemical energy and cause harm via three mechanisms:

Primary injury
Pressure wave causing barotrauma due to over-, then under-pressurisation.
- Affects air filled organs
- Risk with:
  - Military trauma
    Civilian primary blast trauma is rare, and associated with:
    - Combustion of air-dust mixtures
      Coal, grain stores.
    - BLEVE
      Gases stored as liquids under pressure explode when heating to a temperature above their boiling point.
  - Underwater explosions
  - Explosions in enclosed spaces
Secondary injury
From projectiles propelled by the explosion.
- Often penetrating injury
Tertiary injury
From movement of air.
- Often blunt trauma
- Patient being thrown into objects
- Building collapse
Quaternary injury
Everything else:
- Burns
- Toxic gases
  - CO
  - CN
- Oxygen depletion
- Dust

Explosions produce three key effects:

Supersonic pressure wave
Rapid ↑ followed by ↓ of atmospheric pressure without mass particle movement.
- ↑ In enclosed spaces due to reflection
Heat
Blast wind created by gases produced during the explosion.
Gas

Epidemiology and Risk Factors

Primary blast injury:

Secondary blast injury:

Tertiary blast injury:

Bedside:

Laboratory:

Imaging:

Other:

Resuscitation:

A
- Intubation
B
- Lung protective ventilation
  - Minimise Pip
    Risk of systemic air embolism due to direct alveolar-venous communication.

Specific therapy:

Supportive care:

Disposition:

Preventative:

Death:

70% occur within 5 minutes of injury due to catastrophic:
- Haemorrhage
- Brain injury

Bersten, A. D., & Handy, J. M. (2018). Oh’s Intensive Care Manual. Elsevier Gezondheidszorg.