Due to the increasing frequency of armed conflicts, terrorist incidents, and industrial mishaps, it is crucial for healthcare professionals to grasp the nature of blast injuries in both civilian and military contexts. These injuries represent a complicated type of trauma that results from the sudden release of energy from an explosion. The level of injury and its types are influenced by factors such as how close one is to the explosion, the blast pressure, and additional elements like flying debris and heat.
A recent video released in the New England Journal of Medicine under the “Video in Clinical Medicine” category, features experts from Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center (BMC), in partnership with the anesthesiology department at Walter Reed National Military Medical Center. They delve into the mechanisms and classifications surrounding blast injuries while sharing crucial information for early diagnosis and treatment.
According to the lead author, Rafael Ortega, MD, FASA, who chairs and teaches anesthesiology at the school, “Managing blast injuries presents a distinct challenge in trauma medicine due to their intricate mechanisms and diverse presentations. A thorough understanding and strategy for these injuries are vital for enhancing patient outcomes.”
The video reviews various types of blast injuries, which include: primary injuries to organs such as the lungs, ears, and intestines resulting from the shock wave; secondary injuries due to trauma from flying debris; tertiary injuries caused by the force of the blast wind on the body; quaternary injuries, which encompass burns, suffocation, and exposure to harmful substances; and quinary injuries that include the health effects of chemical, radiologic, or biological pollutants following an explosion. It also covers different kinds of explosives, including dynamite and Molotov cocktails.
The authors emphasize that explosions can cause damage across numerous organ systems and that recognizing blast injuries necessitates a careful examination to uncover subtle blunt injuries. They advise that the initial assessment should adhere to advanced trauma life support (ATLS) protocols and utilize imaging techniques, such as X-rays, CT scans, and ultrasounds, which are essential in revealing internal injuries. The discussion also includes injuries affecting the pulmonary and gastrointestinal systems, as well as neurological, cardiovascular, facial, auditory, and musculoskeletal systems.
Regarding diagnosis, the authors indicate that ATLS guidelines provide a standardized framework for trauma care following explosions. “Yet, these guidelines should be adapted based on the specific circumstances and the patient’s requirements, with the priority of interventions potentially changing according to clinical judgment and immediate life dangers,” explains Ortega, who also serves as the chief of anesthesiology at BMC.
The authors advocate for a multidisciplinary treatment strategy for blast injuries, tailored to the specific injuries of each patient. “Whenever possible, involve various specialties such as emergency medicine, trauma surgery, neurosurgery, orthopedic surgery, maxillofacial surgery, otolaryngology, and anesthesiology to achieve the best possible patient outcomes,” he notes.
For preventive measures, the authors suggest enhancing public awareness, enforcing stricter safety protocols for explosive materials, utilizing personal protective gear, and designing public environments to reduce the impact of potential explosions.
