This document discusses blast and missile injuries. It defines a blast injury as physical trauma resulting from an explosion. Blast injuries can include internal organ damage, extremity injuries, burns, and injuries to hearing and vision. The mechanisms of injury are classified as primary (direct blast wave), secondary (fragmentation), tertiary (displacement), or quaternary (burns, toxins). Factors like the explosive type, victim characteristics, and environment impact injuries. Common injuries include abdominal wounds, vascular and neurological trauma. Treatment priorities are ABCs, antibiotics, tetanus prophylaxis, debridement, wound care, fasciotomies, stabilization, and definitive care based on injuries.

1. BLAST & MISSILE INJURIES
Prepared by: Supervisor:
Dareevan Mahdi Dr. Qaidar hassawi
Hindreen Omar
Yaseer Saad

2. OBJECTIVES:
 Definition of blast injury
 Classification
 Mechanism of injury
 Effect on the body
 Management

3. WHAT IS BLAST INJURY?
 A blast injury is a complex type of physical trauma
resulting from direct or indirect exposure to an
explosion.
 Blast injuries range from internal organ injuries,
including lung and traumatic brain injury, to extremity
injuries, burns, hearing and vision injury.
 Usually occur as an act of terrorism, firework,
household explosion, industrial accidents, motor
vehicular accidents.
 Types of the Blasts:
1-High order explosive.
2-Low order explosive.

4.  High-order Explosives produce a defining supersonic over-
pressurization shock wave. (Detonation)
 Examples of HE include TNT, C-4, Semtex, nitroglycerin,
dynamite, and ammonium nitrate fuel oil (ANFO).
 Low-order Explosives create a subsonic explosion and lack
HE’s over-pressurization wave. (Deflagration)
 Examples of LE include pipe bombs, gunpowder, and most
pure petroleum-based bombs such as Molotov cocktails or
aircraft improvised as guided missiles.
 HE and LE cause different injury patterns.

5. CLASSIFICATIONS

6. MECHANISM OF INJURY
 Primary blast injuries: injuries due solely to the blast wave. Unique to HE.
It effects gas filled body structures like lungs, GIT and middle ear.
 Secondary blast injuries: resulting from fragmentation wounds from the
explosive device or the environment.
 Tertiary blast or explosive injury: result of displacement of the victim or
environmental structures, is largely blunt traumatic injuries.
 Quaternary explosive injuries: burns, toxin, and radiologic contamination.

8. Hiroshima nuclear bomb radiation effect

9. FACTORS AFFECTING
MORBIDITY AND MORTALITY
 Agent: missile size and weight and types.
 Host :gender, age, weight, and fitness.
 Environment: closed or open space structural
collapse reflecting or shielding surfaces building and
non structural debris air and liquid hazards.

10. EXPECTED INJURIES
FOLLOWING MISSILE ATTACKS
 Victims of terrorist explosions are more severely
injured than victims of other types of trauma.
 The need for abdominal, vascular, and neurosurgical
procedure is higher, the extend of injuries is also more
severe and more complex compared with the victims
of other forms of trauma.
 Effect of the blast and heat waves, and multiple
penetrating injuries are common among victims and
are hallmark of such attacks.

11. EFFECT ON THE BODY SYSTEMS

12. TRAUMATIC AMPUTATION
 Traumatic amputation is loss of a body part usually a
finger, toe, arm or leg.
 Are common injuries, particularly following explosions,
and, in addition, many survivors require primary
amputation for unsalvageable injuries or to save their
life.

14. COMPARTMENT SYNDROME
 Compartment syndrome is most often seen in lower
leg, but can also affect other closed anatomic space
or body cavity.
 Clinical picture:
 Excessive pain out of proportion
 The muscles become tense, solid and hard
 Other signs of ischemia appear including pallor and
paraesthesia.

15. MANAGEMENT
 History
 Physical Examination
 Investigations
 Treatment

16. HISTORY
 Focused history about :
 1- explosive device details.
 2-Device location, open or closed space, surrounding
structure( urban or rural setting ).
 3-Victim: distance of the victim from the detonation
center.
 4- Personal protective equipment(PPE).
 5-Status of other casualties.
 6- Flash burns.

21. Treatment

22. Initial treatment:
Priority goes to life threatening conditions of
ABCDEs paradigm the only pertinent parameter
in the limbs is peripheral hemorrhage due to a
lesion in major blood vessels.
 control of peripheral hemorrhage is an
emergency and requires immediate
intervention.
 Control the airway and breathing
 Take care for patient with shock
 Immobilization
 Care for amputated part

23. EXTERNAL BLEEDING
CONTROL
 Place sterile dressing on wound.
 Apply direct pressure with gloved hand
 If needed put another dressing on the top of
first and keep applying pressure
 If needed apply pressure bandage
 Keep the pressure until bleeding stops
 In case of severe bleeding use tourniquet

24. BLEEDING CONTROL:

26. IF PATIENT IS IN SHOCK:
 Position the patient on back and raise feet and turn head to one
side if there is no spinal or pelvic injuries
 Maintain normal body temperature
Immobilization
If there is spinal o limbs injuries we should immobilize until
definitive treatment.

27. CARE OF THE AMPUTATED
BODY PART
 The amputated part does not need to be cleaned.
 Wrap the amputated part with a dry sterile gauze or clean clothes.
 Put the wrapped amputated part in the plastic bag or other
waterproof container.
 Keep the amputated part cool but do not freeze (place the bag or the
container with the wrapped part on a bed of ice)
 Seek medical attention immediately.

28. TREATMENT PRINCIPLES
 1- Resuscitation ( ABCDE).
 2-Penicillin.
 3-Anti tetanus.
 4-Debridement.
 5-Wash.
 6-Fasciotomize.
 7-Pack.
 8-Stablize.
 9-Follow up.
 10-Definitive treatment according to the injury.

30. REFRENCES:
 WAR SURGERY, VOLUME 2
 Department of health and human services-USA
 Parker PG(ii) initial medical and surgical
management.carr orthopedics2006
 Baily and loves short practic of surgery 26th edition.
 Medscape

31. THANK YOU