Blast Injury

The CDC document referred to previously makes for chilling reading. As a primary care physician what might I expect to have to deal with? The acute management of blast victims seems to be something most primary care physicians are unlikely to have encountered. Let's hope it stays that way.

Primary care physicians might be involved in the acute management of blast victims, but they are also likely to see people in the days and weeks following a blast. Whilst the psychological consequences can be serious and severe, there may also be developing physical causes for some symptoms.

The potential number of people seeking treatment in the first wave of casualties. It seems that roughly half present in the first hour but if buildings have collapsed it will take longer to get to the receiving centre and the injuries are likely to be more severe. Also, the walking wounded arrive first, the more serious casualties arrive later. Exposure to the blast produces predictable injuries. In particular the blast shockwave has a deleterious effect on gas filled structures.

Injuries to be expected:

• Up to 10% have eye injuries and these are not always symptomatic, so seek them out.
• Bradycardia, apnoea and hypotension are the cardinal signs of blast lung. Suspect it in the dyspnoeic, those coughing or those with haemoptysis after exposure to a blast. CXR and supportive management.
• Middle ear damage - always examine the auditory canal.
• Abdominal trauma including perforation, mesenteric shear injuries and haemorrhage. Sometimes these can present late, so proper examination, observation and re-examination are required.
• Brain injury from concussion to more severe damage to vessels and brain tissue. Consider brain injury in any victim complaining of headache, fatique, poor concentration, insomnia or lethargy, even days after the event this could represent brain injury.

I hope I never have to refer to the CDC document in a live situation, but for anyone receiving acutely injured blast victims it at least points the way.