Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • 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 structures2. Wave propagation transfers energy to internal sites +++ Epidemiology + • 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 +++ Symptoms and Signs + • 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 +++ Imaging Findings + • Chest film: May be normal or show pneumothorax, pneumomediastinum, or infiltrates + • Must evaluate for associated penetrating trauma + • ABG of trauma evaluation• Chest film, pelvic x-ray, and abdominal CT scans useful in stable patients + • 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) +++ Surgery +++ Indications + • Muscle devitalization• Penetrating injury• Cleansing of wounds• Removal of foreign bodies +++ 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] Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.