​Pathophysiology of blast injury - Dr. Kallgren

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

On-scene triage
- same as any other mass casualty event (START)
- danger to first responders from secondary blast, building collapse

ED Response
- 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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