Explosion injury
Explosion injury
- An explosion is a phenomenon resulting from sudden release of energy which is then dissipated by a blast wave, by translocation of objects, or by the generation of heat. Injuries in explosion occur due to four factors
1) Blast or shock wave
- When an explosion occurs, the explosive material produces a large volume of gas and releases a large amount of energy.
- It produces a ‘shock wave’ which spread concentrically from the site of explosion.
- The injuries depend on the enviornment in which blast occurs :-
Air blast (most common) :
Explosion occurs in air.
There is barotrauma to air filled hollow organs.
- Tympanic membrane (ear drum) is most sensitive and most commonly injured.
- Lung is the second organ to be injured and is the most commonly injured hollow organ and most common cause of life threatening injury.
- Other parts injured are middle ear, cochlea, eyes, bowels, mesentery, omentum and brain. Homogenous solid organs like liver and muscles are usually not affected.
- Under water blast (explosion under water):
- Gastrointestinal tract is injured most commonly.
- Lungs are also injured.
Solid blast :
- Explosive is detonated near a rigid/solid structure and wave of energy spreads through it.
- If people are in contact with that rigid structure, injuries take place.
- The injuries are mostly skeletal; fracture of legs and vertebral column are more common.
- GIT damage is more common than lung.
2) Flame or hot gases
- Burns or burning of body may occur.
3) Flying missiles (debris)
- Flying pieces of explosive debris may be driven through air against the skin causing bruises, abrasions, lacerations, and ragged perforations.
4) Anoxia
- Various gases liberated during explosion may cause anoxia, e.g. carbon monoxide, nitrous oxide, nitric oxide, HCN and SO,
CLASSIFICATION OF BLAST INJURIES
Primary injuries
- Caused by blast overpressure waves, or shock waves
- Person is close to exploding ammunition, such as a land mine.
- Gas filled structures are most susceptible as air is easily compressible than water
- Blast lung (pulmonary barotrauma)
- Abdominal haemorrhage and perforation
- TM rupture and middle ear damage
- Globe (eye) rupture
- Concussion
- Gastrointestinal injuries may present after a delay of hours or even days.
- Absence ofexternal injuries; thus internal injuries are frequently unrecognized andtheir severity underestimated.
Secondary injuries
- Caused by fragmentation and other objects propelled by the explosion.
- Results from flying debris, broken glass, loose pieces and bomb fragmentsany body part can be affected.
- Penetratingtrauma with visible bleeding.
Tertiary injuries
- Displacement of air by the explosion creates a blast wind that can throw victims against solid objects.
- Injuries resulting from this typeof traumatic impact are referred to as tertiary blastinjuries.
- May present as some combination of blunt and penetrating trauma, including bone fractures and coup contre-coup injuries.
- Young children, because they weigh less thanadults, are at particular risk of tertiary injury.
Quaternary injuries or other miscellaneous named injuries,
- All explosion-related injuries, illnesses or diseases not due to primary, secondary, ortertiary mechanisms.
- Burns (flash, partial, and full thickness)
- Crush injuries
- Closed and open brain injury
- Asthma, COPD, or other breathing problems from dust, smoke, or toxic fumes
- Angina Hyperglycemia
- Hypertension Traumatic amputations quickly result in death, and are thus rare in survivors,and are often accompanied by significant other injuries.
- Psychiatric injury
Exam Important
- In blast injury, tympanic membrane is the first organ to be damaged.
- The structures injured by the primary blast wave, in order of prevalence, are the middle ear, the lungs and the bowel
- Organ is least vulnerable to the blast wave is liver
- Most common organ affected in underwater blast is intestine
- Primary Injury : It is due to shock wave which causes injury to hollow organs. e.g. ears, lungs, eyes, GIT
- Secondary Injury: These are due to flying debris (missiles).
- Tertiary injuries: Displacement of air by the explosion creates a blast wind that can throw victims against solid objects.
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