Blast injury, eye injury, near drowning

Blast injuries

It refers to the injuries sustained from a blast wave from high explosives that can cause multisystem trauma

Bombs and explosions

can cause unique patterns of injury seldom seen outside combat

code white

it means high alert or there are blasts that occurred in an institution or a specific place

All bomb

events have the potential for chemical and/or radiological contamination

Primary Blast Injury

• Injury from over-pressurization force (blast wave) impacting the body surface

  • Examples: TM rupture

  • Pulmonary damage

  • Air embolization

  • Hollow viscus injury

Secondary Blast Injury

• Injury from projectiles (bomb fragment, flying debris)

  • examples: Fragmentation injuries

  • Blunt trauma

  • Penetrating trauma

Tertiary blast injury

• injuries from displacement of victim by the blast wind

  • ex. Blunt/penetrating trauma

  • Fractures

  • Traumatic amputations

Quaternary blast injury

• All other injuries from the blast

  • ex. Crush injuries

  • Burns

  • asphyxia

  • Exacerbations of chronic illness

Eye injuries

Can result from direct blow, foreign bodies, or inadvertent scratching

• Immediate pain

• Vision changes

• Redness

• Visible foreign material in the eye

ASSESSMENT OF EYE INJURIES

Enucleation of the eye

is the removal of the entire globe and its intraocular content to save the eyeball and the eyesight. If there is fracture around the eye, it compresses the optic nerve that will result in loss of perception of the vision. There will be no picture that will pass through rods and cones

Near drowning

it refers to surviving, temporarily, at least the physiologic effect decreased of O2 in blood (hypoxemia) and acidosis that result from submersion in fluid

freshwater aspiration

changes in the character of the lung surfactant result in exudation of protein rich plasma in the alveoli. Thus, increased permeability happens leading to pulmonary edema and hypoxemia

saltwater aspiration

the hypertonicity of sea water exerts an osmotic force, which pulls fluid from pulmonary capillaries into the alveoli. The resulting intrapulmonary shunt causes hypoxemia.

Pneumonia

Particulate matter such as sand or mud, chemical irritants, gastric contents, that can be aspirated along water may result in ____.

Dry Near Drowning

The victim doesn't aspirate fluid but suffers respiratory obstruction or asphyxia

Wet Near Drowning

The victim aspirates fluid and suffers asphyxia or secondary changes due to fluid aspiration

Secondary near drowning

the victim suffers recurrence of respiratory distress (usually aspiration pneumonia or pulmonary edema) within minutes or 1 to 2 days after a near-drowning accident

• Apnea

• Shallow or gasping respirations

• Substernal chest pain

• Asystole

• Tachycardia or bradycardia

• Restlessness

• Confusion

• Unconsciousness

• Vomiting

• abdominal distention

• cough with pink, frothy sputum

signs and symptoms of near drowning

• ABC, begin CPR, 100% O2

• stabilize neck

• intubate

• insert NGT for decompression, IFC, IV

• Sodium bicarb for acidosis

• suction if needed and ECG

Management