Question

The nursing staff in the emergency department are placed on alert for a Level I disaster at a local mall. A bomb exploded, and there were multiple causalities as a result. A field disaster triage was set up, and the hospital was notified of a bus load of patients who would arrive at the emergency department for needed care. The ambulance will bring patients needing emergent care. (Leaming Objective 4)

 a. What physical injuries may occur after the primary blast event, and what management is needed?

 b. What physical injuries may occur after the secondary blast phase, and what management is needed?

 c. Explain the sequence of applying Person Protective Equipment, include googles and a face mask with shield.

 d. Explain the sequence of taking off Personal Protective Equipment, imclude goggles and a face mask with shield.  

Answer 1

a)Primary blast injury occurs when the blast wave hits the body.Body parts affected includes air filled organs such as ears, lungs, stomach, and intestines and the organs surrounded by fluids such as brain and spine. Injury includes pulmonary barotrauma,abdominal haemorrhage and perforation,tympanic membrane rupture,eye rupture,concussion

Management:

1)administration of supplemental oxygen via non-rebreather mask and monitor oxygen saturation using pulse oximetry.If the patient’s oxygen saturation deteriorates, endotracheal intubation may be necessary.2)The patient is placed in Trendelenburg and left lateral decubitus position to help trap any air in the apex of the heart.If the patient develops a tension pneumothorax, the patient will require needle thoracentesis decompression. 3)administer intravenous fluids conservatively to avoid pulmonary oedema.4)Monitor neurological status of the patient using Glasgow Coma scale.5)Watch for nausea, vomiting, hematemesis, abdominal pain, and/or hypovolemia; on physical examination the patient may have focal or diffuse abdominal tenderness, rebound tenderness, guarding, and/or diminished bowel sounds.6)Watch for any blood or fluid coming from either ear, and probing of the ear is avoided.

b)Secondary blast injury includes being hit by flying debris may cause either blunt or penetrating trauma. 8 Exposed areas of the body are at most risk to injury, including the eyes, thorax, and abdomen .

Mangement:

1)Identify patient’s soft tissue injuries and apply hemorrhage control techniques.2)If the patient becomes hypovolemic due to excess blood loss or internal injuries, administration of IV fluids are required.3)Eye injuries due to bomb fragments are covered with a protective shield.

c)Sequence of applying personal protective equipments:

1)Gown  2)Mask 3)Goggles and face shield 4)Gloves

d)Sequence of taking off personal protective equiments:

1)Gloves 2)Goggles and face shield 3)Gown 4) Mask