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  • • Injuries occur from the effects of the blast itself, propelled foreign bodies, or falling objects

    • Pathophysiology involves 2 mechanisms:

    • 1. Crush injury from rapid displacement of the body wall, leading to laceration and contusion of underlying structures

      2. Wave propagation transfers energy to internal sites

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Epidemiology

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  • • Fireworks, household explosions, industrial accidents

    • Urban guerrilla warfare such as letter bombs, suitcase bombs, car bombs

    • 10% of casualties have deep injuries to chest or abdomen

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Symptoms and Signs

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  • • Depend on proximity to blast, space confinement, and detonation size

    • Large explosion causes multiple foreign body impregnations, bruises, abrasions, and lacerations

    • Blast-induced shock may be result of myocardial depression without compensatory circulatory vasoconstriction

    • Lung damage from rupture of alveoli and hemorrhage

    • Can cause pneumatic rupture of esophagus or bowel

    • Letter bombs tend to injure eyes, hands, ears, and face

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Imaging Findings

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  • Chest film: May be normal or show pneumothorax, pneumomediastinum, or infiltrates

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  • • Must evaluate for associated penetrating trauma

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  • • ABG of trauma evaluation

    • Chest film, pelvic x-ray, and abdominal CT scans useful in stable patients

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  • • Severe injuries with shock from blood loss or hypoxia require resuscitative measures

    • Usual criteria for exploring penetrating wounds of the thorax or abdomen

    • High index of suspicion for hollow organ perforation (especially if victim was submerged at time of blast)

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Surgery

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Indications

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  • • Muscle devitalization

    • Penetrating injury

    • Cleansing of wounds

    • Removal of foreign bodies

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References

Davis TP et al: Distribution and care of shipboard blast injuries (USS Cole DDG-67). J Trauma 2003;55:1022.  [PubMed: 14676645]
Frykberg ER: Medical management of disasters and mass casualties from terrorist bombings: how can we cope? J Trauma 2002;53:201.  [PubMed: 12169923]
Guy RJ et al: Physiologic responses to primary blast. J Trauma 1998;45:983.  [PubMed: 9867037]
Shaham D, et al: The role of radiology in terror injuries. Isr Med Assoc J 2002;4:564.  [PubMed: 12120475]

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