Blast Injuries

Table of Contents

Aliases

None noted

Patient Care Goals

  1. Maintain patient and provider safety by identifying ongoing threats at the scene of an explosion
  2. Identify multi-system injuries which may result from a blast, including possible toxic contamination
  3. Prioritize treatment of multi-system injuries to minimize patient morbidity

Patient Presentation

Inclusion Criteria

  1. Patients exposed to explosive force. Injuries may include any or all of the following:
    1. Blunt trauma
    2. Penetrating trauma
    3. Burns
    4. Pressure-related injuries (barotrauma)
    5. Toxic chemical contamination

Exclusion Criteria

No recommendations

Patient Management

Assessment

  1. Hemorrhage Control
    1. Assess for and stop severe hemorrhage [see Extremity Trauma/External Hemorrhage Management guideline]
  2. Airway
    1. Assess airway patency
    2. Consider possible thermal or chemical burns to airway
  3. Breathing
    1. Evaluate adequacy of respiratory effort, oxygenation, quality of lung sounds, and chest wall integrity
    2. Consider possible pneumothorax or tension pneumothorax (as a result of penetrating/ blunt trauma or barotrauma)
  4. Circulation
    1. Look for evidence of external hemorrhage
    2. Assess BP, pulse, skin color/character, and distal capillary refill for signs of shock
  5. Disability
    1. Assess patient responsiveness (AVPU) and level of consciousness (GCS) [see Appendix VII]
    2. Assess pupils
    3. Assess gross motor movement and sensation of extremities
  6. Exposure
    1. Rapid evaluation of entire skin surface, including back (log roll), to identify blunt or penetrating injuries

Treatment and Interventions

  1. Hemorrhage control:
    1. Control any severe external hemorrhage [see Extremity Trauma/External Hemorrhage Management guideline]
  2. Airway:
    1. Secure airway, utilizing airway maneuvers, airway adjuncts, extraglottic device, or endotracheal tube [see Airway Management guideline]
    2. If thermal or chemical burn to airway is suspected, early airway control is vital
  3. Breathing:
    1. Administer oxygen as appropriate with a target of achieving 94-98% saturation.
    2. Assist respirations as needed
    3. Cover any open chest wounds with occlusive dressing
    4. If patient has evidence of tension pneumothorax, perform pleural decompression
  4. Circulation:
    1. Establish IV access with two large bore IVs or IOs
    2. Administer NS, per the General Trauma Management guideline
    3. If patient is burned, administer NS per the Burns guideline
  5. Disability:
    1. If evidence of head injury, treat per the Head Injury guideline
    2. Apply spinal precautions, per the Spinal Care guideline
    3. Monitor GCS during transport to assess for changes
  6. Exposure:
    1. Keep patient warm to prevent hypothermia

Notes – Blast Injuries