Title: Blast Injuries: Practice Essentials, Background, Pathophysiology
Headings: Blast Injuries
Blast Injuries
Practice Essentials
Signs and symptoms
Diagnosis
Management

Content: A negative FAST examination is unreliable in the setting of penetrating trauma to the abdomen, flank, buttocks, or back, and it should be followed up with CT examination of the abdomen and pelvis. See Workup for more detail. Management
Prehospital care
Screen for radioactive contamination with a hand-held Geiger counter for any explosion that may involve radioactive material, including any explosion that may have been deliberately set; if radioactive material is detected, decontamination of personnel and equipment as well as notification of the receiving hospital is required
Rapidly identify patients with life-threatening external hemorrhage and control bleeding; early use of tourniquets may be life-saving, especially in the setting of multiple seriously injured casualties
High-flow oxygen should be administered to all patients with respiratory distress, abnormal findings on auscultation, and evidence of significant thoracic trauma
Avoid administration of large quantities of IV fluid in patients with a high suspicion of ongoing internal hemorrhage; judicious fluid boluses may be required if patients exhibit signs and symptoms of inadequate perfusion, such as deteriorating mental status
Initiate measures to reduce heat loss and prevent hypothermia
Emergency department care
Penetrating wounds (secondary blast injury), blunt trauma (tertiary/secondary blast injury), and burns receive standard treatment
Shrapnel wounds (secondary blast injury) are treated as low-velocity gunshot wounds
Hemodynamically unstable patients with significant trauma may benefit from early use of packed red blood cells (PRBC) and fresh frozen plasma (FFP) in a 1:1 ratio, as well as platelets
Consider early use of fresh whole blood if available
In patients with severe trauma, also consider cryoprecipitate and recombinant factor VIIa
In patients with traumatic brain injury, prevention of hypoxia and hypotension is critical
Because pulmonary contusion tends to evolve over several hours, a period of observation and repeat radiography may be necessary if indicated; definitive airway management and ventilatory support may be required
If abdominal pain persists or vomiting develops, consider admitting the patient for observation, as intestinal hematoma may be difficult to detect in the ED
In patients with open wounds from blasts, consider broad-spectrum prophylactic antibiotics and provide tetanus toxoid if immunization is not up to date
See Treatment and Medication for more detail. Background
Blast injuries traditionally are divided into 4 categories: primary, secondary, tertiary, and quaternary (or miscellaneous) injuries. A patient may be injured by more than one of these mechanisms. [