Blast Injuries Blast injuries A Blast can result
Blast Injuries
Blast injuries A Blast can result from: • an explosion in the workplace (explosives or chemicals) • at home (a gas heater) • from fireworks • a result of terrorist attack. 18 December 2021 Coffs Harbour Divisional Training 2
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London terrorist attacks • Royal London Hospital admitted 194 patients to its accident and emergency (A&E) department • Patients presented with embedded foreign bodies, blast lung injury, mangled lower limbs and multiple severely contaminated fragment wounds – forcing surgeons to recommend amputation. Coffs Harbour Divisional Training
London terrorist attacks • surgeons performed 11 primary limb amputations in seven patients, nine limb fasciotomies, five laparotomies and one sternotomy. • Thirty-eight of the walking wounded patients (20%) presented with tympanic membrane ruptures, a primary marker for blast lung injury Coffs Harbour Divisional Training
London terrorist attacks Removal of foreign material • Those patients who underwent removal of foreign or dead material returned to the operating theatre every 48 hours • The 48 -hour [observation] usually revealed the wounds were still heavily contaminated, • A number of the patients had to go back to theatre about five times before the wounds were deemed clean enough Coffs Harbour Divisional Training
Mechanism of Injury • The principle mechanism behind the injuries is the creation of tremendous kinetic energy over a short time. • There are four general types of injuries caused by an explosion: 18 December 2021 Coffs Harbour Divisional Training 7
Mechanism of Injury 1. direct blast injuries—primary injuries 2. injuries caused by flying objects accelerated by the explosion— secondary injuries 3. injuries sustained by the victim's movement—tertiary injuries 4. miscellaneous injuries caused by the explosion or the explosives 18 December 2021 Coffs Harbour Divisional Training 8
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Types of explosives There are two general types of explosives: 1. High-order 2. Low-order Each type of explosive will create slightly different injury patterns Coffs Harbour Divisional Training
High-order explosives • High-order explosives are chemicals with a very high rate of reaction. • These chemicals include nitroglycerin, dynamite, C-4, and a mixture of ammonium nitrate and fuel oil. Coffs Harbour Divisional Training +
High-order explosives On detonation, the chemical is converted into a gas at a very high temperature and pressure. + Coffs Harbour Divisional Training
Overpressure • The intense rise in pressure or blast wave is often called "overpressure. " • Typically, the pressure wave increases instantly and then quickly decays. • The amount of damage from the pressure wave depends on a number of variables 18 December 2021 Coffs Harbour Divisional Training 13
Overpressure • The increase in pressure can be so intense and abrupt that it shatters surrounding materials and structures. • With time and distance, the wave deteriorates until it becomes a mere sound wave. 18 December 2021 Coffs Harbour Divisional Training 14
Overpressure Damage or injuries to a person from a blast wave that engulfs the entire body will depend on the magnitude of the pressure spike and the duration of the pressure or force 18 December 2021 Coffs Harbour Divisional Training 15
Low-order explosives • Low-order explosives are designed to burn, then relatively slowly release energy. • Often, these explosives are called "propellants" because they propel an object such as a bullet through a barrel. • Low-order explosives include pipe bombs, gunpowder, and Molotov cocktails 18 December 2021 Coffs Harbour Divisional Training 16
Primary blast injuries • Primary blast injuries result from the blast wave created by high-order explosions and have an overall incidence of 20 percent • Primary blast injuries commonly affect the ear, respiratory system, and gastrointestinal system. • The brain and cardiovascular system may also be affected 18 December 2021 Coffs Harbour Divisional Training 17
The ear • In the ear, the eardrum typically ruptures, especially when the overpressure exceeds 5 psi. • With extremely high overpressures, the eardrum may be destroyed and the ossicles (bony structures) can be dislocated or fractured. • At lower pressures, the eardrum may bleed without rupture 18 December 2021 Coffs Harbour Divisional Training 18
The ear 18 December 2021 Coffs Harbour Divisional Training 19
The ear 18 December 2021 Coffs Harbour Divisional Training 20
Secondary blast injuries • Secondary blast injuries are caused by debris propelled by the blast wind of the explosion, resulting in both penetrating and blunt trauma. • Individuals far from the scene of an explosion can be struck and injured by this debris. • For example, after the 1998 terrorist bombing of the U. S. Embassy in Nairobi, flying glass wounded victims up to 2 kilometers away 18 December 2021 Coffs Harbour Divisional Training 21
Secondary injuries produced by nuts 18 December 2021 Coffs Harbour Divisional Training and bolts packed with explosive. 22
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Signs & Symptoms • • • Coughing up frothy blood Chest pain Possible bleeding from ears Possible fractures Multiple soft tissue injuries Shock 18 December 2021 Coffs Harbour Divisional Training 24
Management • • Follow DRSABCD Call 000 for an ambulance Place casualty in comfortable position Control bleeding Care for wounds and burns Immobilise fractures Monitor breathing and other signs 18 December 2021 Coffs Harbour Divisional Training 25
Embedded objects Glass or debris from a blast may penetrate through a casualty’s skin and embed in the tissues 18 December 2021 Coffs Harbour Divisional Training 26
Embedded objects • DO NOT try to remove it as it may be plugging the wound and restricting bleeding • DO NOT exert any pressure over the object • DO NOT try to cut the end of the object unless its size makes it unmanageable 18 December 2021 Coffs Harbour Divisional Training 27
Management 1. Control bleeding by applying pressure to the surrounding areas but not on the object 2. Place padding around the object or place a ring pad over the object and a bandage 18 December 2021 Coffs Harbour Divisional Training 28
Amputated parts With any amputation the aim is to: • Minimise blood loss and shock • Preserve the amputated part because it may be possible to re-attach a finger, or limb by microsurgery. 18 December 2021 Coffs Harbour Divisional Training 29
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Management • Follow DRSABCD • Call 000 for an ambulance • Apply direct pressure to the wound and raise the limb to control blood loss • Apply sterile dressing 18 December 2021 Coffs Harbour Divisional Training 31
Management The amputated part • DO NOT wash or soak the amputated part • Wrap in gauze or material and place in a watertight container (plastic bag) • Place sealed container in cold water with ice added • Send to hospital with casualty 18 December 2021 Coffs Harbour Divisional Training 32
Questions 18 December 2021 Coffs Harbour Divisional Training 33
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