Diagnosis and Management of Blast Injuries in the Emergency Department (Trauma CME)

Points & Pearls Excerpt

• Explosive events can result from terrorist bombings, industrial and construction accidents, planned avalanches, and fireworks. The increase in injuries and fatalities is primarily due to homemade/recreational explosives.²
• Low-order explosives include gunpowder, pipe bombs, Molotov cocktails, and smokeless and black powder. These more often produce fragmentation injuries and thermal burns.
• High-order explosives include TNT, ammonium nitrate, fuel oil, dynamite, and nitroglycerine. These typically produce higher temperatures over a shorter period of time, and produce a overpressure blast wave.
• Exposure to peak overpressure in a confined space (eg, a vehicle or underwater) produces greater injury.
• Primary blast injury in closed spaces has a high likelihood for tympanic membrane rupture; however, it has a low sensitivity and specificity as a biomarker in blast injuries as a whole.⁴⁹