Blast Lung Injurys Symptoms

Current patterns in worldwide terrorist activity have increased the potential for casualties related to explosions, yet few civilian health care providers in the United States have experience treating patients with explosion-related injuries. Emergency care providers are urged to learn more about the physics of explosions and other types of injuries that can result. Basic clinical information is provided here to inform practitioners of the presentation, evaluation, management, and outcomes of BLIs.

Clinical Presentation

Symptoms may include dyspnea, hemoptysis, cough, and chest pain.
Signs may include tachypnea, hypoxia, cyanosis, apnea, wheezing, decreased breath sounds, and hemodynamic instability.
Associated pathology may include bronchopleural fistula, air emboli, and hemothoraces or pneumothoraces.
Other injuries may be present.

Initial triage, trauma resuscitation, treatment, and transfer should follow standard protocols; however some diagnostic or therapeutic options may be limited in a disaster or mass casualty situation.

In general, managing BLI is similar to caring for pulmonary contusion, which requires judicious fluid use and administration ensuring tissue perfusion without volume overload.
Clinical interventions

All patients with suspected or confirmed BLI should receive supplemental high flow oxygen sufficient to prevent hypoxemia (delivery may include non-rebreather masks, continuous positive airway pressure, or endotracheal intubation).

Impending airway compromise, secondary edema, injury, or massive hemoptysis requires immediate intervention to secure the airway. Patients with massive hemoptysis or significant air leaks may benefit from selective bronchus intubation.

Clinical evidence of or suspicion for a hemothorax or pneumothorax warrants prompt decompression.

If ventilatory failure is imminent or occurs, patients should be intubated; however, caution should be used in the decision to intubate patients, as mechanical ventilation and positive end pressure may increase the risk of alveolar rupture and air embolism.

High flow oxygen should be administered if air embolism is suspected, and the patient should be placed in prone, semi-left lateral, or left lateral positions. Patients treated for air emboli should be transferred to Jacobi Hyperbaric Center or Brookdale University Hospital

To find out more go to The Bureau of EMS web page it is designed to provide members of the EMS community with a place to turn with questions regarding the pressing issues of disaster preparedness and preparing for a possible Weapons of Mass Destruction (WMD) incident LINK

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