Blast injuries
What is the aim of damage control and immediate surgery?
The aim of damage control surgery is to deliver a resuscitated patient to intensive care so that definitive surgery can happen in a stable environment. It reduces morbidity from sepsis, gas gangrene and recurrent trips to theatre All blast wounds are contaminated and are NOT closed primarily. Due to the contamination of these types of wounds, the best surgical treatment is early wound excision
When do you use debriment following the injuries?
The greater the tissue damage, the more extensive and complete wound excision needs to be. All dead and infected tissue is removed, the wound is left open
How do you classify it?
primary, secondary, tertiary and quaeternary
How is bone stabilization incorporated?
it is paramount to reduce further neurovascular injury, reduce soft tissue deformation, reduce pain, allow easier casualty handling and start the healing process. Initial stabilization will likely be with plaster of Paris, external fixation or skeletal traction. Definitive stabilization (internal fixation) is usually avoided in the unstable patient who is at risk of infection
What can be the indications for it?
multiple life-threatening injuries, acidosis (pH <7.25), hypothermia (temperature <34C), shock on presentation, combined hollow viscus and vascular or vascularized, organ injury, coagulopathy, mass casualty situations. Hemorrhage can be controlled by ligation, shunting, or repair of injured vessels. For the patient in extremis, clamping or shunting of major vessels is recommended over repair.
What is primary injuries?
(blast overpressure): these injuries are caused by blast overpressure waves, or shock waves. These are especially likely when a person is close to an exploding munition, such as a land mine. Affected organs: air-fluid filled organs like ears, lungs and organs of the GIT. GIT injuries may present after a delay of hours or even days. Injury from blast overpressure is a pressure and time dependent injury. By increasing the pressure or its duration, the severity of injury will also increase. · Ears: Tympanic membrane may be perforated, the sound receptors can be permanently damaged and can cause injury neurovasculature within the auditory system.The combination can lead to hearing loss, tinnitus, headache and vertigo
How do you diagnose and treat the patient with this?
Diagnosis: clinical with thorough history. X-ray, USG maybe done. Pan-CT if possible Treatment: Steps of these injuries can be summarized as: resuscitation urgent surgery, penicillin, anti-tetanus immunoglobulin, debridement, wash, fasciotomies, pack, stabilize. Resuscitation: ABC and vital signs (pulse, respiratory rate, temperature, blood pressure) · A= Securing an airway (chin lift and jaw thrust) · B= treating breathing problems (insert chest tube, intubate the patient) · C= supporting the circulation with IV fluids / blood transfusions. Stop bleeding with pressure, dressings, tourniquets or traction
Tertiary injuries?
Displacement of air by the explosion creates a blast wind that can throw victims against solid objects. Tertiary injuries may present as some combination of blunt and penetrating trauma, including bone fractures and coup contre-coup injuries. Crush injuries and open or closed brain traumas also result.
What scoring system is useful in the treatment of this condition?
E: Entry wound · X: Exit wound · C: Cavity · F: Fracture · V: Vital structure injury · M: Metallic fragments
What are the two surgical systems that you use?
Fasciotomies: There should be a low threshold to perform limb fasciotomies. Amputations: Many blast injuries cause traumatic amputation of limbs, or produce limbs that are so mangled, that amputation is the only option.
What is the definiton of it?
complex type of physical trauma resulting from direct or indirect exposure to an explosion. Blast injuries occur with the detonation of high-order explosives as well as the deflagration of low order explosives. These injuries are worse when the explosion occurs in a confined space.
What can traumatic amputation lead to?
quickly result in death, unless there are available skilled medical personnel or others with the ability for rapid ground or air medical evacuation to an appropriate facility in time. Because of this, injuries of this type are generally rare in survivors.
Secondary injuries can be?
these are caused by fragmentation and other objects propelled by the explosion. These injuries may affect any part of the body and sometimes result in penetrating trauma with visible bleeding. Fragmentation wounds may be lethal and therefore many anti-personnel bombs are designed to generate fragments. Most casualties are caused by secondary as debris can easily be propelled for hundreds to thousands of meters.
Quartenary injuries?
these injuries, are all other injuries not included in the first three classes. These include flash burns, smoke inhalation, chemical injuries and respiratory injuries
