Article Impact Level: HIGH Data Quality: STRONG Summary of New England Journal of Medicine, 391(23). https://doi.org/10.1056/NEJMvcm2408353 Dr. Rafael Ortega et al.
Points
- Blast injuries are categorized into five types—primary (blast wave effects), secondary (debris impact), tertiary (blast wind forces), quaternary (burns and toxic exposures), and quinary (contaminants like chemical agents)—to systematically address their diverse presentations.
- Advanced trauma life support (ATLS) protocols and imaging tools like CT scans, radiographs, and ultrasonography are crucial for diagnosing and managing injuries across multiple organ systems, with a focus on silent internal injuries requiring clinical vigilance.
- Effective treatment involves a coordinated approach across specialties, including trauma surgery, neurosurgery, otolaryngology, maxillofacial surgery, and anesthesiology, to address the varied and complex nature of blast injuries.
- Public education, safety regulations, personal protective equipment, and designing public spaces to reduce blast impact are emphasized as strategies to minimize the frequency and severity of blast injuries.
- The study underscores the unique challenges of blast injuries in armed conflicts, terrorist attacks, and industrial accidents, advocating for a combination of advanced clinical management and preventive strategies to improve outcomes.
Summary
Blast injuries resulting from the explosive release of energy represent a unique and complex challenge in trauma medicine, particularly in the context of armed conflicts, terrorist attacks, and industrial accidents. A recent video published in the New England Journal of Medicine by experts from Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, and Walter Reed National Military Medical Center provides a detailed overview of the mechanisms, classifications, and management strategies for blast injuries. These injuries are categorized into five types: primary injuries caused by the blast wave (e.g., pulmonary barotrauma, tympanic membrane rupture, bowel perforations), secondary injuries from debris, tertiary injuries from blast wind forces, quaternary injuries including burns and toxic exposures, and quinary injuries due to contaminants like chemical or radiological agents. This classification aids in systematically addressing the varied presentations of blast injuries across multiple organ systems.
The authors emphasize the importance of advanced trauma life support (ATLS) protocols in the initial assessment, supplemented by imaging modalities such as radiographs, CT scans, and ultrasonography to detect internal injuries, particularly in the pulmonary, gastrointestinal, neurological, cardiovascular, and auditory systems. For example, silent injuries, such as blunt trauma to internal organs, often require a high index of suspicion for accurate diagnosis. However, the authors highlight that clinical judgment should guide the prioritization of interventions based on the patient’s immediate life-threatening conditions. A multidisciplinary approach involving trauma surgery, neurosurgery, otolaryngology, maxillofacial surgery, and anesthesiology is recommended to optimize patient outcomes.
In addition to clinical management, the authors advocate for preventive strategies, including public education on explosive safety, enforcement of safety regulations, and the use of personal protective equipment. These measures and designing public spaces to mitigate blast impact can reduce the prevalence and severity of blast injuries in civilian and military settings, ultimately enhancing patient survival and recovery.
Link to the article: https://www.nejm.org/doi/full/10.1056/NEJMvcm2408353
References Ortega, R., Vietor, R., Arbelaez, C., Feliu, D., Nozari, A., & Ortoleva, J. (2024). Blast injuries. New England Journal of Medicine, 391(23). https://doi.org/10.1056/NEJMvcm2408353
