Emergency Care for Bomb Blast Injuries

Bomb Blast Patient Assessment

• A patient after a bomb blast will show significant injuries.
• The patient's condition will often appear worse than it is, especially to untrained eyes immediately after the incident.

Skin Injuries

• Skin is the largest organ and important for protecting the body and regulating its temperature.
• Skin also senses heat, cold, touch, and pain.
• Its layers include the epidermis (outer layer of dead cells), dermis (deeper layer with glands), and subcutaneous layer (below the dermis).
• Closed injuries have intact skin and typically include contusions (bruises) and hematomas (blood collections under the skin).
• Open injuries have breaks in the skin and include abrasions, lacerations, avulsions, punctures, and amputations.

Soft-Tissue Injuries Overview

• Soft tissue injuries often appear worse than they actually are.
• Immediately after cleaning, an injury might look less severe.
• Closed injuries include contusions and hematomas: resulting from blunt force trauma.
• Hematoma is a large collection of blood beneath the skin, caused by the rupture of larger blood vessels.
• Crush injuries can cause internal organ rupture and severe internal bleeding.
• Open injuries include abrasions (superficial), lacerations (varying depth), avulsions (skin/tissue flaps), penetrations/punctures (caused by sharp objects), and amputations.

Emergency Medical Care for Patients with Soft Tissue Injuries

• Immediately administer appropriate procedures for preventing further damage and infection.
• Isolate the patient.
• Administer appropriate supplemental oxygenation.
• Stabilize the patient and control any bleeding.
• Clean and dress the wounds correctly.

Burns

• Burns can result in severe disability, disfigurement, and fluid loss.
• Loss of protective barrier may result in hypothermia and infection.
• Emergency care initially focuses on stabilizing vital signs, preventing further injuries, or managing life-threatening conditions.
• Burns are classified by depth (superficial, partial thickness, full thickness).
• The extent of the burn (in terms of percentage of body surface area [BSA]) must be assessed to determine its severity, along with other patient factors like age and pre-existing conditions.

Burns: Severity

• The location of the burn, especially on face/upper airway or hands/feet/genitalia, significantly elevates the severity of the injury.
• Younger patients (under 5) and older adults (over 55) are at greater risk following burn injuries.
• Critical burns include full-thickness burns involving specific areas (such as hands, feet, face, or genitals), as well as burns associated with respiratory injury and full-thickness burns affecting over 10% of the body.
• Moderate Burns include full-thickness burns between 2% and 10% BSA, partial-thickness over 15% to 30% of the BSA and superficial burns over 50% BSA.
• Minor burns include full-thickness burns under 2% and partial thickness burns of less than 15% affected BSA.

Emergency Care for Burns

• Stop the burning process with water or saline.
• Remove smoldering clothing and jewelry.
• Administer necessary oxygenation.
• Monitor the airway for closure, and prevent contamination.
• Cover the burn area.
• Do not break blisters.
• Transport to specialized care facility as appropriate.

Infant and Child Considerations

• Children may have greater surface area to total body size and are susceptible to greater fluid loss as part of the burn injury.
• Critical burns include full or partial thickness burns than 20% of the BSA.
• Moderate burns in children include partial thickness burns of 10%-20% of the BSA.
• Minor burns in children are partial thickness burns less than 10% of the BSA.
• Children experience a higher risk for shock, airway problems, or hypothermia.
• Additional considerations include the possibility of child abuse.

Chemical Burns

• Brush off any chemical powders.
• Flush the burn with large amounts of water.
• Do not contaminate uninjured areas.

Electrical Burns

• Do not attempt to remove a patient from the electrical source unless you are trained to do so.
• Monitor airway and administer oxygen as necessary or refer to an expert service.
• Treat any soft tissue injuries.
• Be aware for entrance and exit wound.

Summary

• The presentation describes different types of soft tissue injuries, their assessment, and emergency medical care.