#1 Types of Injuries from primary injuries, blast effects from overpressure.
Severe respiratory insufficiency cause by a blast effect.
Immediate death. Death from an explosion can be instantaneous and result from massive pulmonary hemorrhage accompanied by rapid suffocation. Other causes of immediate death from an explosion include pulmonary air embolism,
Because of the blast wave and its damage, the patient dies in spite of immediate and high-quality care. EMTs and paramedics should consider death in any victim of an explosion under the following conditions:
Primary blast injuries. Primary blast injuries result from the blast wave created by high-order explosions will depend on several factors, including
1) Peak pressure of the initial blast wave.
2) Duration of overpressurization.
3) Medium in which the explosion occurs. (water, atmosphere)
4) Distance from the source of the explosion.
Primary blast injuries commonly affect the ear, respiratory system, and gastrointestinal system. The brain and cardiovascular system may also be affected (Table 1). In the ear, the eardrum typically ruptures, especially when the overpressure exceeds 5 psi. With extremely high overpressures, the eardrum may be destroyed and the ossicles (bony structures) can be dislocated or fractured. At lower pressures, the eardrum may bleed without rupture. Signs and symptoms of eardrum rupture include pain, loss of hearing, and tinnitus. Blood may be present in the ear canal.
The respiratory system can sustain significant injury typically as a result of supersonic pressure caused by the blast wave. Overpressurization at 40 psi will cause pulmonary injury such as pneumothorax, air embolism, interstitial emphysema, pneuomediastinum, and subcutaneous emphysema (Figure 3). Pulmonary contusion is most common and generally found on the side of the body that was closest to the explosion. A patient who survives the initial explosion may develop "blast lung" immediately, but signs and symptoms can be delayed up to 48 hours after the event.
Blast injury to the gastrointestinal tract should be suspected in anyone exposed to an explosion with signs and symptoms that include abdominal pain, nausea, vomiting, hematemesis, rectal pain, testicular pain, unexplained hypovolemia, and any finding suggesting an acute abdomen.11,12 The colon is the most common site of hemorrhage and perforation. The perforated bowel may be immediately evident or may perforate after a delay of up to 48 hours. Solid organ laceration and testicular rupture are also seen with primary blast injury, but are less frequent and often associated with large blast loads.
Primary blast injury can cause concussion or traumatic brain injury, although this finding is difficult to differentiate from a concussion because of impact with another object.
Myocardial contusion accompanied by signs of dysrhythmia or hypotension may develop.
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Master terrorist Abu Musab Zarqawi mumbled a few words as he lay mortally wounded on a stretcher amid the rubble of his bombed-out meeting place, made a feeble attempt to get up and then died surrounded by U.S. Army soldiers.