1. Primary injury - overpressure from blast waves
- air-containing organs most susceptible to injury
- damage to lungs (pulmonary blast injury) most common injury to immediate survivors
2. Secondary injury - from projectiles
3. Tertiary injury - victim thrown against wall, etc
4. Other injuries - burns, smoke inhalation, delayed complication
- same as any other mass casualty event (START)
- danger to first responders from secondary blast, building collapse
- most immediate survivors will not have life threatening injury, but triage is challenging
- close monitoring and thorough evaluation for development of pulmonary blast injury
- positive pressure ventilation and air transport increase risk for developing air embolism
- nearly all patients with PBI will also have ruptured TMs
- empiric antibiotics for all patients with soft tissue injury or if concerned for intraabdominal injury
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