A 23-year-old female, completely entranced by 4th of July fireworks ducks the barrier and gets a little too close to the excitement. While ashing her cigarette next to a giant box labelled “explosives,” she hears a loud noise and is promptly thrown through the air, landing 25 feet away, injured.
What are the primary, secondary, and tertiary blast injuries that she may have suffered? How do you evaluate for them?
Answer
Primary blast injury: barotrauma from the blast pressure wave. This usually affects hollow/air containing structures. Look at the TMs. If ruptured, this usually heralds more serious injuries to other hollow structures like lung (more common), or intestine (less common). Secondary blast injury: solid projectiles in the blast hitting the patient. Make sure to expose the patient and look for signs of penetrating injuries. Often intentional explosives are filled with nails or other projectiles designed to injure patients. Tertiary blast injuries are injuries sustained when a person is thrown through the air into a solid object like a hard surface or a wall. These are often associated with fractures and dislocations, blunt trunk trauma. At minimum, every patient should get a chest xray as well as evaluating for extremity injuries.
By Dr. Sally Bogoch and Dr. Andrew Grock
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