3 Bomb, Blast, and Crush Injuries

Question 1

the universal decontamination fluid

Answer 1

warm water

hosing a patient from head to toe (or showering) for 5 mins will decontaminate most ambulatory patients

Question 2

if with eye pain, what to do

Answer 2

irrigate with sterile normal saline

Question 3

what to use when patients are likely to have significantly delayed transpoft from a scene

Answer 3

Secondary Assessment of Victim Endpoinnt

Category 1 - patients who will die regardless of how much care they receive

Category 2 - patients who will survive whether or not they receive care

Category 3 - patients who will benefit significantly from austere field interventions

Question 4

primary injury from blast effect

Answer 4

caused by a direct effect of blast wave over pressure on tissue

affects mostly air-filled structures, e.g. lugns, ears, and GI tract

Question 5

mechanisms of primary injury from blasts

Answer 5

Spalling
Shearing
Implosion

Question 6

What is spalling

Answer 6

spalling is displacement and fragmentation of a dense medium into a less dense medium
ex:
-blast wave causing the lung parenchyma to explode into the alveolar space like a geyser

Question 7

what is shearing

Answer 7

sometimes called inertia

a stress caused by the blast wave traveling through different tissue densities at different veolocities

ex:
-blast wave traveling trough th pulmonary vessels and air spaces, resulting in ruptured vascular and bronhial pedicles

Question 8

what is implosion

Answer 8

opposit of spalling, where the less dense material is displaced into denser material

ex:
- blast wave causing the flexible air spaces to rebound to greater than original size, sometimes causing air embolism from the alveoli into the pulmonary vessels

Question 9

what is a secondary blast injury

Answer 9

due to collateral damage from flying objects

Question 10

what is a tertiary blast injury

Answer 10

results from the victim being propelled through the air and striking stationary objects

Question 11

what is quaternary blast injury

Answer 11

result of burns, smoke inhalation, or chemicl agent release

Question 12

most commonly injured abdominal organs in blasts

Answer 12

terminal ileum and cecum

Question 13

“signature injury of the war in Iraq”

Answer 13

mild TBI

Question 14

likely to be the most commonly encountered life-threatening finding in blasts

Answer 14

exsanguination from wounds

Question 15

most common cause of preventable death in penetrating trauma

Answer 15

hemorrhage

Question 16

tourniquets have been successfully used for up to -_____ in bettlefield situations

Answer 16

6 hours

Question 17

describe compartment syndrome

Answer 17

COMPARTMENT SYNDROME
-crush injury that produces ongoing ischemia of a fascial muscle compartment

-defined as increased pressure within a confined space that leads to microvascular compromise and ultimately to cell death as a result of O2 starvation

Question 18

most seriou complication of crush syndrome

Answer 18

renal failure
-multifactorial
—systemic hypoperfusion
—renal vasoconstriction
—nephrotoxicity from myoglobin
—uric acid and phosphate precipitation in the DT

Question 19

remarks on myoglobin

Answer 19

myoglobin is indirectly nephrotoxic through the formation of ferriheximate, which produces free hydroxyl radicals and, combined with lipid peroxidation, damages the kidney

Question 20

normal muscle compartment pressure

Answer 20

<10 mm Hg

Question 21

pressures of _____ produce muscle uschemia

Answer 21

> 30 mm Hg

irreversible nerve and muscle damage occurs after 4-6 hours

Question 22

primary cause of delayed death in crush syndrome

Answer 22

renal failure

Question 23

5 P’s of compartment syndome

Answer 23

*Pain
paresthesias
Passive stretch
pressure
†Pulseleness

*Pain is the most common and consistent symptom
†Pulselesness is least reliable becuase compartment syndrome is a disorder of the MICROVASCULATURE; the major vessles are frequently unaffected. It also occus only in the late stage

Question 24

management of compartment syndrome

Answer 24

PNSS
1000 mL/hour for 2 hours, then
500 mL/hour

UO should be 200-300mL/hour
(5-7 L every 24 hours)

Question 25

the threefold immediate effects of hyperbaric oxygen therapy (HBOT) in compartment syndrome

Answer 25

1. enhanced oxygen at the tissue level
2. increased oxygen delivery per unit of blood flow, and
3. edema reduction