injuries poisoning
Explosives and Blast Injuries
Diagnosis of Explosive and Blast Injuries
Clinical evaluation Imaging studies as indicated by findings Patients are evaluated as for most multiple trauma casualties (see Evaluation and Treatment ), except that special effort is directed at identifying blast injury, particularly blast lung (and consequent air embolism), ear trauma, occult penetrating injury, and crush injury. Apnea, bradycardia, and hypotension are the clinical triad classically associated with blast lung injury. Tympanic membrane rupture has been considered to predict blast lung injury, but pharyngeal petechiae may be a better predictor. Chest x-ray is done, which may show a characteristic butterfly pattern. Cardiac monitoring is done in all patients. Patients with possible crush injury are tested for myoglobinuria, hyperkalemia, and ECG changes. In blast injuries, less seriously injured patients often bypass prehospital triage and go directly to hospitals, possibly overwhelming medical resources in advance of the later arrival of more seriously injured patients. On-scene triage differs from standard trauma triage mainly in that blast injuries may be more difficult to recognize initially, so initial triage should be geared toward identifying blast lung, blast abdomen, and acute crush syndrome in addition to more obvious injuries. 