Bomb, Blast And Crush Injuries Flashcards
displacement and fragmentation of a dense medium into a less dense medium.
An example is a blast wave causing the lung parenchyma to explode into the alveolar space like a geyser
Spalling
sometimes called inertia, is a stress caused by the blast wave traveling through different tissue densities at different velocities.
An example is the blast wave traveling through the pulmonary vessels and air spaces, resulting in ruptured vascular and bronchial pedicles
Shearing
opposite of spalling, where the less dense material is displaced into denser material.
An example is the 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
Implosion
due to collateral damage from flying objects and shrapnel
secondary blast injury
results from the victim being propelled through the air and striking stationary objects
Tertiary blast injury
result of burns, smoke inhalation, or chemical agent release
quaternary blast injury
is the most common fatal primary blast injury
Pulmonary barotrauma
The tympanic membrane ruptures at__________ of dynamic overpressure.
1 to 8 psi
True or false
Keep tidal volume to 6 to 7 mL/kg ideal body weight to limit the peak inspiratory pressure and to minimize ventilator-induced lung barotrauma
True
True or false
Air is a poor conductor of blast-wave energy; thus, patients who were subjected to enough energy to damage abdominal organs probably were situated near the explosive device.
True
True or false
Exsanguination from wounds is likely to be the most commonly encountered life-threatening finding. Military experience has shown that hemorrhage is the most common cause of preventable death in penetrating trauma.
True
the most serious complication of crush syndrome
Renal failure
Compartment syndrome often presents with the five “P’s”:
pain,
paresthesias,
passive stretch,
pressure, and
pulselessness
the most common and consistent symptom in compartment syndrome
Pain
Treatment in Compartment syndrome
Establish two large-bore IV lines and administer normal saline with a 1- to 2-L bolus.
Avoid Ringer’s lactate and other potassium-containing fluids, because fatal hyperkalemia may occur, even in the absence of renal failure.
Initiate IV fluid rate at 1000 mL/h, and then reduce to 500 mL/h after 2 hours.
Urine output should be approximately 200 to 300 mL/h (5 to 7 L every 24 hours) for an adult.
Monitor serial serum potassium levels.
Admit the patient to an intensive care unit setting to monitor fluid administration and electrolyte status.
