![]() ![]() īlast forces are propagated through lung parenchyma, causing widespread disruption at the capillary-alveolar membrane and tearing of alveolar septae. It is found on autopsy in a high proportion of immediate fatalities and body armour is not protective against injury. ![]() The second most susceptible organ to blast injury is the lung. Intact tympanic membranes do not exclude primary blast injury to other organs. Seeking early antibiotics in the event of infection.Simple advice can be given to patients regarding: ĮD medics must ensure that otological examination is performed and recorded and all patients, whether conscious of deafness or not, should undergo audiometric follow-up. In the ED, little treatment is required for tympanic membrane rupture. Vertigo is relatively rare following blast injury and, although perilymph fistulae should be excluded in patients with unresolving vertigo at two weeks, it is usually attributable to concussional syndromes following head injury. In one study, 36.7% of patients with blast lung injury had intact tympanic membranes.ĭisruption of the ossicular chain, most often at the incudomalleolar joint, and distortion or destruction of the oval or round windows, are rarer primary blast injuries but cause significant morbidity. Īlthough intact tympanic membranes were once relied upon as a marker of absence of exposure to significant over-pressures, significant primary blast injuries may occur in its absence. ![]() Persisting deafness and tinnitus results from tympanic membrane rupture that may occur at pressures as low as 5 psi and this usually occurs at the pars tensa. Many victims will suffer a short-lived but profound period of sensorineural deafness and tinnitus that resolves within hours. ![]() It is essential therefore that every patient involved in a blast, when appropriate and taking into consideration other injuries, be assessed otologically in the course of their hospital assessment. The ear is designed to efficiently transmit pressure waves and is the organ most likely to sustain a primary blast injury. The initial management of a blast victim is the same as for any multi-trauma patient Ears In order to adequately assess a patient at risk of primary blast injury, one must have an awareness of the types of injury likely to have been sustained during an explosion and actively seek their symptoms and signs. Primary blast injury remains, however, a significant cause of morbidity and mortality and consideration to its effects should be given in the ED. Most injuries following explosions are due to secondary and tertiary blast injuries. Initial management should be given in accordance with standard trauma management. Patients attending the emergency department (ED) following a blast are more likely to be critically ill with higher injury severity scores and more body areas injured than in other forms of multi-trauma. These shear forces result in the tearing of tissues and organs and may result in injury to their attachments. Shear waves are longer duration and lower velocity transverse pressure waves that result from differences between the rates of acceleration and deceleration of tissues with different densities, in response to the blast waves. This blast wave dissipates rapidly and is followed by the recoil of the surrounding air and a slightly longer period of low (sub-atmospheric) pressure. This results in a well-demarcated expanding shock wave of extremely high pressure. On detonation, a blast wave is generated by the rapid transformation of explosive material from a solid or liquid to a gas as it almost instantaneously increases in volume up to 100,000 times. The incidence of explosions and resultant blast injuries increased throughout the twentieth century.Īlthough some of these events are attributable to increasing industrialisation, they are predominantly the result of attacks using explosive weapons. Blast injuries can cause multisystem and life-threatening injuries, which require complex triage, diagnostic, and management challenges for the health care provider. Barotrauma resulting from underwater diving and pulmonary barotrauma from mechanical ventilation will not be discussed. These are the direct result of exposure to the significant atmospheric pressure changes generated from detonation of explosive devices. This may be the result of many mechanisms but this module concentrates on the epidemiology, pathophysiology, pattern of injury and management of primary blast injuries. Barotrauma refers to physical damage to body tissues by changes in ambient pressure. ![]()
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