Hidden Perils of Blast Injuries: Unseen Threats and the Fight for Survival
Blast injuries present a unique challenge in trauma medicine due to their complex mechanisms and varied presentations. A comprehensive understanding and approach to patient injury management is essential to improve patient outcomes.
Blast injuries result from the explosive release of energy, causing complex trauma that can affect both civilians and military personnel. These injuries stem from high-pressure waves (explosive release of energy) and propelled debris, leading to varying internal and external damage levels. Explosions generate blast waves that can cause severe injury depending on the type of explosive, proximity to the blast, blast pressure, and environmental factors. High-order explosives create supersonic overpressure waves, while low-order explosives produce blast winds that primarily result in ballistic and thermal injuries.
Blast injuries are classified into five categories: primary (blast wave affecting lungs, ears, and gastrointestinal tract), secondary (flying debris causing lacerations and penetrating trauma), tertiary (displacement of the body by the blast wind, causing blunt trauma), quaternary (burns, asphyxiation, and toxic substance exposure), and quinary (chemical, radiologic, or biologic contaminants).
Multiple organ systems can be affected, requiring a high index of suspicion to identify silent blunt injuries. Initial assessment follows Advanced Trauma Life Support (ATLS) protocols, with imaging methods like radiography, CT scans, and ultrasonography crucial for detecting internal injuries. Common findings include avulsion or degloving injuries, penetrating wounds, severe pain, neurologic deficits, and internal organ damage. For effective management, radiologic evaluations identify soft-tissue defects, foreign objects, fractures, and internal injuries.
ATLS protocols following explosions offer a structured approach to trauma care but should be tailored to the patient for rapid assessment and management of life-threatening conditions. A multidisciplinary approach is essential, with specialists from various fields collaborating for optimal patient outcomes. Performance of an eFAST (extended focused assessment with sonography for trauma) rapidly assesses for potentially life-threatening internal injuries that can quickly lead to shock. Continuous monitoring of vital signs, rapid intervention for complications, and ongoing reassessment of treatment is crucial. Recovery involves physical therapy, occupational therapy, and psychological support to address issues like PTSD. Effective management and rehabilitation are key to improving patient outcomes.
Video summary can be found here: https://www.nejm.org/doi/full/10.1056/NEJMvcm2408353
Blast Injuries. Rafael Ortega, Robert Vietor, Christian Arbelaez, Dylan Feliu, Ala Nozari, and Jamel Ortoleva N Engl J Med. 2024 Dec 12;391(23):e58. DOI: 10.1056/NEJMvcm2408353
The Blast Injury Coordinating Office does not endorse NEJM or its affiliates. The work presented is that of the author(s) and does not imply an official DOD, Defense Health Agency or a U.S. Army Medical Research and Development Command stance.
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