8.2. INJURIES FROM EXPLOSIONS

Related titles

Absent.

Purpose of assistance

1. Maintaining the safety of the EMD specialist and the patient by identifying active threats at the site of the explosion.
2. Identification of multisystem injuries caused by the explosion, including possible toxin contamination.
3. Setting priorities in the treatment of multisystem trauma to minimize complications.

Description of the patient

Inclusion criteria

Patients who survived the explosion. Injuries may include one or all of the following:

a) blunt trauma;
b) penetrating trauma;
c) burns;
d) barotrauma;
e) infection toxic elements.

Exclusion criteria

Absent.

Providing assistance to the patient

Status assessment

1. Bleeding control.
Assess for and stop massive bleeding (see Extremity Injury/External Bleeding Control).

2. Respiratory tract:

a) assess patency;
b) suspect the possible presence of thermal or chemical burns.

3. Breathing:

a) assess the adequacy of breathing, oxygenation, respiratory sounds in the chest, the integrity of the chest walls;
b) suspect the possible presence of pneumothorax or tension pneumothorax (due to penetrating/blunt trauma or barotrauma).

4. Circulation:

a) assess the presence of external bleeding;
b) assess blood pressure, pulse, skin color and condition, distal capillary refill for signs of shock.

5. Disability:

a) assess the neurological status – use the AVPU and SHKG scale (see Appendix 3);
b) assess the general motility of the limbs;
c) assess the condition pupils.

6. Influence of the external environment.
Quick examination of the whole body, including the back (turning over the fixed patient – log-roll technique) to detect blunt and penetrating wounds.

Treatment and intervention

1. Bleeding control.
Stop massive bleeding (see “Injury of the limbs/External bleeding control” guideline).

2. Respiratory tract:

a) ensure patency using manual techniques, auxiliary airways, supraglottic airways or an endotracheal tube (according to the guideline “Airway Control”);
b) if chemical agents are suspected or thermal burns, airway control becomes a vital necessity.

3. Breathing:

a) administer oxygen therapy to achieve saturation at the level of 94-98%;
b) conduct assisted ventilation;
c) in case of penetrating chest injury apply a semi-occlusive bandage;
d) if the patient has signs of tension pneumothorax, perform needle decompression.

4. Circulation.
Get IV access with two high-throughput IV or IV catheters:

a) enter an isotonic physiological solution or a combined medicine with the composition of sodium chloride + potassium chloride + sodium lactate + calcium chloride according to the instruction “General trauma”;
b) in the presence of burns, administer an infusion with an isotonic physiological solution or a combined medicine with the composition of sodium chloride + potassium chloride + sodium lactate + calcium chloride according to the “Burns” instruction.

5. Disability:

a) with clinical signs of TBI – see guideline “Head injury”;
b) immobilize the spine according to the guideline “Help with spinal cord injury”;
c) monitor the SKG indicator during transportation to detect changes.

6. Environmental exposure.
Keep the patient warm to prevent hypothermia.

Patient safety

1. Ensuring the safety of the scene is especially important during an explosion:

a) suspect possible further explosions, the safety of surrounding buildings, possible contamination with toxic materials, the presence of poisonous gases and other dangers;
b) in the event of a possible terrorist act, suspect the possible presence additional explosive devices.

2. Remove the patient from the scene as quickly as possible, taking into account safety and feasibility.

3. In the presence of op ics in the patient (thermal, chemical, burns of the respiratory tract), take the patient to the burn center.

Useful information for training

Key points

1. The safety of the scene is critically important when going to the places of explosions and blast injuries.

2. Blast trauma patients may have complex, multisystem injuries, including blunt and penetrating trauma, shrapnel injuries, barotrauma, burns, and toxic exposure.

3. Suspect possible airway trauma, potential airway burns require prompt and aggressive airway control.

4. Minimize IV fluid resuscitation if there are no signs of shock.

5. Potential damage due to barotrauma:

a) tense pneumothorax:

• • • • hypotension or other signs of shock associated with decreased or absent breath sounds, jugular venous distention, and/or tracheal deviation;

b) perforation of the eardrums, which leads to deafness, which in turn can make it difficult to assess the patient’s state of consciousness and ability to follow your commands.

6. Immediate transportation to a trauma or burn unit is desirable if this is possible.

Corresponding evaluation results

Signs of multisystem trauma, especially:

a) damage/burns of the respiratory tract;
b) lung barotrauma;
c) contamination with toxic substances.

Key elements of documentation

1. State of the respiratory tract and interventions.

2. State of breathing:

a) quality of respiratory sounds (bilaterally the same);
b) adequacy of respiratory efforts;
c) oxygenation.

3. Documentation of burns, including the total area affected by burns (see the instruction “Burns”).

4. Documentation of contamination with toxic chemicals.

Criteria for the effectiveness of aid provision

1. Assessment of airway patency and early and aggressive control.
2. Correct intravenous infusion therapy.
3. Transportation to the trauma or burn department.