06.h.v • Blast injuries

ICRC (International Committee of the Red Cross) describe three injury patterns for an antipersonnel mine.

BMJ 1991;303:1509–12

Management

<C>ABCDE appoach

Have a high index of suspicion for bowel injury – clinical diagnosis, ultrasound and CT can be inconclusive: diagnostic peritoneal lavage may reveal vegetable matter and raised amylase/ white count

  • Associated ballistic injury?
  • Associated blunt injury?
  • Associated burn?

Pattern 1

Usually from standing on buried mine

  • usually sustain traumatic amputation of foot or leg
  • other leg often affected
  • one or both legs may need amputation
  • injuries to genitalia are common

Pattern 2

Multiple fragments from mine triggered near casualty
Injuries to face, head, chest, abdomen and limbs

Pattern 3

From handling mines: deminers removing mines or children playing with them.
Severe head, face, eye injuries

Blast lung

  • uncommon in survivors who reach hospital
  • may develop over 24–48 hours
  • Consider rFV11a

Perforating ear drum

  • perforated TMs are NOT a reliable indicator that blast lung will develop
  • hearing loss and/or balance disorder requires urgent ENT assessment