Blast Trauma Scenario

Simulation DebriefingSimulation Debriefing

Blast Trauma Scenario

Blast InjuriesBlast Injuries

Sudden forceSudden force Rapid accelerationRapid acceleration High peak velocityHigh peak velocity ““Shock waves” stretch & tear soft Shock waves” stretch & tear soft

tissues, shatter bonestissues, shatter bones

Injuries from Injuries from ExplosionsExplosions Blunt trauma Blunt trauma (blast force, flying objects, (blast force, flying objects,

falls)falls)

Penetrating traumaPenetrating trauma BarotraumaBarotrauma

Secondary InjuriesSecondary Injuries

Crush injuriesCrush injuries AmputationsAmputations BurnsBurns Toxic inhalationsToxic inhalations Contaminants Contaminants (chemical & radiation)(chemical & radiation)

Primary Blast InjuryPrimary Blast Injury

Hemotympanum or ruptureHemotympanum or rupture Hearing lossHearing loss

Primary Blast InjuryPrimary Blast Injury

Pulmonary lacerationsPulmonary lacerations Hemo- or pneumothoraxHemo- or pneumothorax Bronchopleural fistulasBronchopleural fistulas Pulmonary contusionsPulmonary contusions Systemic arterial air embolismSystemic arterial air embolism Distal ischemiaDistal ischemia Massive hemoptysisMassive hemoptysis

Primary Blast InjuryPrimary Blast Injury

GI hemorrhageGI hemorrhage Gastrointestinal ischemiaGastrointestinal ischemia Transmural gastric & bowel tearsTransmural gastric & bowel tears PeritonitisPeritonitis May be occultMay be occult

Primary Blast InjuryPrimary Blast Injury

Shattering of boneShattering of bone

Treatment CaveatsTreatment Caveats

Stop exanguinating hemorrhage.Stop exanguinating hemorrhage. Pneumothorax is common.Pneumothorax is common. Pulmonary venous air embolism is Pulmonary venous air embolism is

possible.possible. PPV worsens both.PPV worsens both. Exertion may worsen blast lung Exertion may worsen blast lung

injury.injury.

Treatment CaveatsTreatment Caveats

Shock & burn injuries require Shock & burn injuries require large volumes of IV fluids. large volumes of IV fluids.

Continued fluid resuscitation for Continued fluid resuscitation for burn injury:burn injury:

~23% ~23% BSABSA x 70 kg x 2 cc/kg = 3220 cc x 70 kg x 2 cc/kg = 3220 cc One half in first 8 hrs = 1610 ccOne half in first 8 hrs = 1610 cc Rate per hour = 200 ccRate per hour = 200 cc

Treatment CaveatsTreatment Caveats

Rapid infusion of IV crystalloids Rapid infusion of IV crystalloids may worsen pulmonary may worsen pulmonary contusions. contusions.

Use small boluses; reevaluate Use small boluses; reevaluate frequently.frequently.

Treatment CaveatsTreatment Caveats

Consider crush injury, rhabdomyolysis, & Consider crush injury, rhabdomyolysis, & compartment syndrome if entrapment.compartment syndrome if entrapment.

Consider toxic gas inhalation from fires.Consider toxic gas inhalation from fires. Consider deliberate radiation or chemical Consider deliberate radiation or chemical

contamination.contamination. Otherwise, follow standard management Otherwise, follow standard management

strategy for blunt & penetrating trauma.strategy for blunt & penetrating trauma.

Optimal Management Optimal Management StrategyStrategy

Setting affects strategy:Setting affects strategy: Small community hospital Small community hospital

with limited resources & staffwith limited resources & staff

Extent of stabilization may vary.Extent of stabilization may vary.

Optimal Management Optimal Management StrategyStrategy

See “Blast Trauma Simulation Skill See “Blast Trauma Simulation Skill Sets.”Sets.”

Basic or advancedBasic or advanced

CreditsCredits

Project funded by:Project funded by:Regional Bioterrorism Prepardedness ProjectRegional Bioterrorism Prepardedness ProjectMichigan Department of Community Health &Michigan Department of Community Health &Health Resources and Services AdministrationHealth Resources and Services Administration

Project Director:Project Director:William Fales, MDWilliam Fales, MDMSU/KCMSMSU/KCMS

Simulation development:Simulation development:Richard Lammers, MDRichard Lammers, MDMSU/KCMSMSU/KCMS

With technical assistance from:With technical assistance from:Stu Myers, BS, EMT-PStu Myers, BS, EMT-PJason Schlautman, MDJason Schlautman, MD