Question

2. 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. (Learning Objective 5) What physical injuries may occur after the primary blast event, and what management is needed? a. What physical injuries may occur after the secondary blast phase, and what management is needed? h.

Answer 1

a Primary blast injury occurs when the blast wave hits the body and causes injuries ears,lungs,stomach and intestines.Blast lug,tympanic membrane rupture,head injuries,abdominal haemorrhage and internal-organ injury.

Management

• The patient with air embolus must be turned to the left lateral prone position ,brought to the hospital and place into the hyperbaric chamber.
• Other blast lung injuries will need supplemental oxygen and if the injuries are severe ,the patient will need invasive mechanical ventilation
• For Tymbanic membrane rupture-the patient will need examination to make sure foreign bodies are not resent.
• The ruptured ear drum will heal itself within several weeks and very few will need hearing aids in the future.
• Medication for pain relief and vertigo are provided.
• Head injuries will need monitoring for 24 hours for any changes in LOC ,pupils,or neurological deficits or onset of seizures which needs further treatment.

b Secondary blast injury includes being hit by flying debris which can cause both penetrating and direct impact trauma.

Management

• Patients will be treated at the disaster triage and sent home.
• Injuries requiring emergent care will require the patient to arrive to the hospital via ambulance,such as patient suffering from traumatic amputation .or by the bus taking the patients to the emergency room for care of fractures or needing stiches.