Blast Injuries: Evaluation & Patient Management [Micro Lecture]

In today’s micro-lecture, Australian Paramedical College Hon. Snr. Lecturer Sam Willis talks about blast injuries and the typical situations you might find when you are called to someone with a blast injury.

Today we’re going to talk about blast injuries. Now as a paramedic, blast injuries are not that common. However, think about the typical situations you might find when you are called to somebody with a blast injury. It could be some kind of chemical or the type of incident involving an explosion in an industrial place. It could be some kind of act of terrorism which are becoming more and more common place. It could be some kind of accident involving a camping trip and I’m sure you guys can think about other situations involving blasts. Now when you are faced with it, there are at least three different phases of a blast that you need to be mindful of and these are called primary, secondary, and tertiary. Now, yes, this is the theoretical side to it, but there’s also a practical side to managing this patient using these key principles.

If you have your patient who’s pretty close to the source of the blast there’s straight away primary injuries from that blast site, now that can involve burns to the face and the body and anywhere basically, if you’re stood right on it, as you can see here, primary blast injuries due to the blast wave itself. Then of course there’s secondary blast injuries, which is due to missiles being propelled by the blast force. Let’s say there’s something around the source of the blast and the all the shrapnel is destroyed and thrown towards the patient, then that’s a secondary blast injury. Then of course, if you imagine your patient being thrown and hitting a wall or hitting some kind of solid object, that’s the tertiary blast injury. As you can see, there are at least three different sources of blast injury for every one blast, you also need to consider the number of patients and not just the type of injuries.

Because of course, as you know, if there’s more injured patients than the healthcare system can deal with, then that’s a major incident and it needs to be declared as a major incident. How do you treat these patients then? You follow the primary, secondary … Primary survey followed by secondary survey. And of course if there are any time critical features, we need to deal with it quickly. Primary survey, your danger, your response, Airway, breathing, and circulation. If you need to immobilise this you do it straight away. If you need to stop any hemorrhages, you do that first. If you need to cut any clothing off as part of the exposure, do it very carefully, because this patient may have significant burns, they may have injuries that are caused by a shrapnel that’s protruding out of the body.

Therefore, you’re going to need to give lots of careful thought to this situation. Lots of pain relief, but whatever you do, make sure you don’t miss any catastrophic hemorrhage and manage the airway appropriately and stop the bleeding as soon as possible. That’s a snapshot of blast injuries. Of course these are linked into mass casualty incidents and a range of the lectures in this series.

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