Professional Documents
Culture Documents
Introduction
Area affected: Irak, Israel, Pakistan, Madrid, 9/11, Beirut Main publications: civilian (Israel), military (Irak) Particularities of blast injury Management of mass casualty events
LE create a subsonic explosion and lack HEs over-pressurization wave. Examples of LE: pipe bombs,
gunpowder, and most pure petroleum-based bombs such as Molotov cocktails or aircraft improvised as guided missiles.
Blast wave
The HE blast wave (over-pressure component) should be distinguished from blast wind (forced super-heated air flow), encountered with both HE and LE. Expansion of gas creating a shock wave: supersonic speed 3000 to 8000m/s Blast wave rapidly looses pressure and velocity with distance and time
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Shear waves:
Transversal waves Asynchronous movement of tissue Possible disruption of attachments ear, lungs, colon, gas-filled organs affected with the damage initiating at the tissue-gas interface
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Blast Injuries: Bus Versus Open-Air Bombings-A Comparative Study of Injuries in Survivors of Open-Air Versus Confined-Space Explosions
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Blast Injuries: Bus Versus Open-Air Bombings-A Comparative Study of Injuries in Survivors of Open-Air Versus Confined-Space Explosions
An overall increased mortality rate with explosions in confined spaces. Immediate survivors of explosions within confined spaces suffer more severe injuries and present to the ED in a less favorable physiologic condition. Confined spaces: higher incidence of primary blast injuries, with a predominance of the more severe pulmonary injuries rather than perforation of tympanic membranes. Burns sustained by victims of explosions in confined spaces affect a larger BSA. No difference in the incidence of significant penetrating trauma, burns, or traumatic amputations between the two settings.
J Trauma Volume 41(6), December 1996, pp 1030-1035
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In the ER
Senior most trauma surgeon take the lead and should define prorities for access to OT Avoid heroic procedures compromising delivery of efficient care to the salvageable victims Risk of undertriage, so repeated assessment should be performed
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Challenges
Many hours and sometimes days are required for the situation to stabilize and eventually normalize Treating teams are physically and emotionally exhausted from the continuous workload, especially when repeat attacks occur within days; Repeated reassessment by the treating teams and SIC to ascertain that all patients receive optimal care is fundamental. In these circumstances, a strong personal commitment by the treating teams and SIC is pivotal to success.
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