8/24/2023 0 Comments Barotrauma ear from a blast![]() ![]() ![]() Although recent bombings have had a widespread effect, they generally do not occur in the same location frequently enough to start a randomized study of any treatment methodology. Another reason is the dispersion in both time and space of these kinds of injuries. This is due partly to the nature of the injury: sudden, random, and unpredictable. There are few meta-analyses and even fewer prospective studies. The literature of blast injuries is replete with case reports and data mining from trauma registries. There were, however, multiple retrospective studies, analyses of case reports, animal studies, and many individual case reports and short series. The terms were used in Boolean combination and separately in each database, as appropriate.Īs might be expected, there were no prospective, randomized, placebo-controlled studies of any treatment. TATP - Triacetone triperoxide, also called TCAP or acetoneįor this review, MEDLINE, Ovid, BestBETs (Best Evidence Topics), Google Scholar, and Google were all searched using the terms blast injury, explosions, bombings, and explosives. PETN - Pentaerythritol tetranitrate (explosive) This issue of Emergency Medicine P RACTICEwill review the current literature, including the potential mechanisms of injury, early signs of these injuries, and the natural course of the problems caused by explosive blasts.ĪNFO - Ammonium nitrate-fuel oil (explosive)ĪTF - Bureau of Alcohol, Tobacco, Firearms and ExplosivesīLEVE - Boiling liquid expanding vapor explosionįAST - Focused abdominal sonography for trauma Research on blast injury is not a new study for those interested in combat medicine. Increasingly, information resources, such as the Internet, terrorist training camps, and even library and television sources, have made the knowledge needed to construct these simple and very effective explosive devices readily available. The use of suicide devices in the US has yet to occur, but given the political climate, the scenario is very likely. 11 These bombers have walked or driven into buses, subways, cafes, residential areas, guard posts, and governmental buildings. 10Recent terror tactics include an increasing use of suicidal/homicidal bombers who deliberately accompany the explosive device (often wearing it) to ensure its maximum effect. 8,9 The London and Madrid bombings (on Jand March 11, 2004, respectively) have forced physicians in other countries to consider or reconsider their potential roles in explosions and blast injuries due to terrorism.īombings are clearly the most common cause of casualties from terrorist incidents. 5-7As a result of the casualties associated with September 11, 2001, more US physicians have had to face the specter of explosion and blast injuries filling their own EDs. 4 Unfortunately, many smaller devices are exploded each year in the United States. This changed abruptly with the destruction of the Alfred P Murrah Federal Building by a truck bomb ? the 1995 blast rocked downtown Oklahoma City and resulted in more than 750 casualties, with 167 fatalities. Prior to 1995, most civilian emergency physicians in the US had neither experience of nor interest in the effects of explosive devices. The obvious concern is when, not if, the practice will spread to the United States. ![]() 2 Unfortunately, the threat of suicide bombing seems to have spread from the Near East to the Far East and back to Europe, as evidenced by both the Madrid and London attacks. But it is only since the advent of terrorist suicide bombings that civilian physicians have become significantly concerned about the cause and treatment of blast injuries. 3 Following WWII, blast injury was intensively investigated in the United States, due to the perceived threat of nuclear warfare. "Blast lung" was the term coined for massive pulmonary hemorrhage from disruption of the alveolar architecture and formation of alveolar-venous fistulas resulting in air embolism. In WWII, a noteworthy number of casualties were found among civilians in both German and British cities after bombing raids. During WWI, blast injury was thought to be a nervous system disorder and labeled "shell shock." (At that time, sychological casualties were lumped together with those who had no visible injuries.) 2 1 Rusca went on to use rabbits as an animal model and demonstrated that the cause of death was pulmonary embolism. Our knowledge of the effects of blast injury dates from the Balkan wars in 1914, when Franchino Rusca, a Swiss researcher, observed 3 soldiers who had been killed by an explosion without evidence of any external in-juries.
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