Rocketman! ED Guide to blast injuries

You are called by EMS to the bedside of a recently arrived patient who presents with shortness of breath from his home after he was attempting to have his own fireworks show. He had periscoped the event on his twitter feed with the hashtag, “waketheneighbors,  however, he had an old iPhone 5 that didn’t have a good zoom function, so he ended up being close to the fireworks as they prematurely detonated. He was knocked backwards and lost consciousness. EMS arrived and found him with headaches, tinnitus and blood from his right ear. Which of the following is true?

A. Lack of otological damage basically excludes serious blast injury to other organs

B. Steroids have been shown to reduce mortality from pulmonary blast injury

C. Lung contusions are the most common form of lung injury

D. Tertiary blast wave injury is the most common cause of death.

References:

Avidan V, Hersch M, Armon Y, Spira R, Aharoni D, Reissman P et al. Blast lung injury: clinical manifestations, treatment, and outcome. Am J Surg 2005; 190(6):927-931

DePalma RG, Burris DG, Champion HR, Hodgson MJ. Blast Injuries. The New England Journal of Medicine 352, 1335-1342. 2005. Ref Type: Generic

Harrisson SE, Kirkman E, Mahoney P. Lessons Learnt from Explosive Attacks. JR Army Med Corps 153[4], 278-282. Ref Type: Generic

Horrocks CL. Blast Injuries: Biophysics, Pathophysiology and Management Principles. JR Army Med Corps 147, 28-40. 2001. Ref Type: Generic

Kizer KW. Dysbarism. In: Tintinalli JE, Kelen GD, Stpczynski JS, editors. Emergency Medicine: A Comprehensive Study Guide 6th edition. 5th ed. Maidenhead: McGraw-Hill; 2003. 1269-1278.

Leibovici D, Gofrit ON, Shapira SC. Eardrum perforation in explosion survivors: is it a marker of pulmonary blast injury? Ann Emerg Med 1999; 34(2):168-172.

Sasser SM, Sattin RW, Hunt RC, Krohmer J. Blast lung injury. Prehosp Emerg Care 2006; 10(2):165-172.

Blake Briggs