blast trauma scenario simulation debriefing blast trauma scenario
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Blast Trauma Scenario
Simulation DebriefingSimulation Debriefing
Blast Trauma Scenario
Blast InjuriesBlast Injuries
Sudden forceSudden force Rapid accelerationRapid acceleration High peak velocityHigh peak velocity ““Shock waves” stretch & tear soft Shock waves” stretch & tear soft
tissues, shatter bonestissues, shatter bones
Injuries from Injuries from ExplosionsExplosions Blunt trauma Blunt trauma (blast force, flying objects, (blast force, flying objects,
falls)falls)
Penetrating traumaPenetrating trauma BarotraumaBarotrauma
Secondary InjuriesSecondary Injuries
Crush injuriesCrush injuries AmputationsAmputations BurnsBurns Toxic inhalationsToxic inhalations Contaminants Contaminants (chemical & radiation)(chemical & radiation)
Primary Blast InjuryPrimary Blast Injury
Hemotympanum or ruptureHemotympanum or rupture Hearing lossHearing loss
Primary Blast InjuryPrimary Blast Injury
Pulmonary lacerationsPulmonary lacerations Hemo- or pneumothoraxHemo- or pneumothorax Bronchopleural fistulasBronchopleural fistulas Pulmonary contusionsPulmonary contusions Systemic arterial air embolismSystemic arterial air embolism Distal ischemiaDistal ischemia Massive hemoptysisMassive hemoptysis
Primary Blast InjuryPrimary Blast Injury
GI hemorrhageGI hemorrhage Gastrointestinal ischemiaGastrointestinal ischemia Transmural gastric & bowel tearsTransmural gastric & bowel tears PeritonitisPeritonitis May be occultMay be occult
Primary Blast InjuryPrimary Blast Injury
Shattering of boneShattering of bone
Treatment CaveatsTreatment Caveats
Stop exanguinating hemorrhage.Stop exanguinating hemorrhage. Pneumothorax is common.Pneumothorax is common. Pulmonary venous air embolism is Pulmonary venous air embolism is
possible.possible. PPV worsens both.PPV worsens both. Exertion may worsen blast lung Exertion may worsen blast lung
injury.injury.
Treatment CaveatsTreatment Caveats
Shock & burn injuries require Shock & burn injuries require large volumes of IV fluids. large volumes of IV fluids.
Continued fluid resuscitation for Continued fluid resuscitation for burn injury:burn injury:
~23% ~23% BSABSA x 70 kg x 2 cc/kg = 3220 cc x 70 kg x 2 cc/kg = 3220 cc One half in first 8 hrs = 1610 ccOne half in first 8 hrs = 1610 cc Rate per hour = 200 ccRate per hour = 200 cc
Treatment CaveatsTreatment Caveats
Rapid infusion of IV crystalloids Rapid infusion of IV crystalloids may worsen pulmonary may worsen pulmonary contusions. contusions.
Use small boluses; reevaluate Use small boluses; reevaluate frequently.frequently.
Treatment CaveatsTreatment Caveats
Consider crush injury, rhabdomyolysis, & Consider crush injury, rhabdomyolysis, & compartment syndrome if entrapment.compartment syndrome if entrapment.
Consider toxic gas inhalation from fires.Consider toxic gas inhalation from fires. Consider deliberate radiation or chemical Consider deliberate radiation or chemical
contamination.contamination. Otherwise, follow standard management Otherwise, follow standard management
strategy for blunt & penetrating trauma.strategy for blunt & penetrating trauma.
Optimal Management Optimal Management StrategyStrategy
Setting affects strategy:Setting affects strategy: Small community hospital Small community hospital
with limited resources & staffwith limited resources & staff
Extent of stabilization may vary.Extent of stabilization may vary.
Optimal Management Optimal Management StrategyStrategy
See “Blast Trauma Simulation Skill See “Blast Trauma Simulation Skill Sets.”Sets.”
Basic or advancedBasic or advanced
CreditsCredits
Project funded by:Project funded by:Regional Bioterrorism Prepardedness ProjectRegional Bioterrorism Prepardedness ProjectMichigan Department of Community Health &Michigan Department of Community Health &Health Resources and Services AdministrationHealth Resources and Services Administration
Project Director:Project Director:William Fales, MDWilliam Fales, MDMSU/KCMSMSU/KCMS
Simulation development:Simulation development:Richard Lammers, MDRichard Lammers, MDMSU/KCMSMSU/KCMS
With technical assistance from:With technical assistance from:Stu Myers, BS, EMT-PStu Myers, BS, EMT-PJason Schlautman, MDJason Schlautman, MD
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