Question

The nursing staff in the emergency department are placed on alert for a level 1 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 busload of patients who would arrive at the emergency department for needed care. The ambulance will bring patients needing emergent care (Learning objective 5)

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?

Answer 1

A blast is considered to be a sudden increase in the volume of a medium that is triggered by a detonation of unstable and highly reactive compounds that generate shockwaves. There are a series of events that occur just after a detonation that divides the category of affected individuals as primary and secondary. After a detonation, the very first event is the rise in temperature and pressure along with the negative suction effect which causes a blast of wind. This wind can carry heavy sharp debris that can cut or harm people in the vicinity.

A. The primary blast event includes blast victims that suffer from damage to ears, lungs, heart, CNS due to the change in pressure of medium or sudden shock due to rise in temperature. The clinical management for primary blast event should begin with ABCs i.e. monitoring breathing, blood circulation, airway, etc. The victim is under sudden shock and thus physical examination has to be undertaken for pupils, chest, stomach.

B.The secondary blast event involves victims that are suffering from blunt cuts, wounds, ocular penetration because of flying debris in the shockwave. In this case, no time must be wasted for any emergency surgery. The victim must be provided oxygen and a broad-spectrum antibiotic should be commenced.