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Primary blast (blast lung) injury — DIPIMC MCQ

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HardPre-Hospital TraumaPrimary blast (blast lung) injuryDIPIMCDipIMC

Twenty minutes after an explosion, a previously walking casualty develops hypoxaemia, dyspnoea and fine bilateral crackles without an external chest wound. What injury and ventilatory principle should be considered?

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Correct answer: A — Primary blast lung requiring oxygen and lung-protective ventilation

The best answer is “Primary blast lung requiring oxygen and lung-protective ventilation”. Delayed respiratory deterioration after blast exposure with diffuse crackles is compatible with primary blast lung from alveolar-capillary disruption and haemorrhage. Give oxygen, monitor closely, restrict unnecessary fluid and use lung-protective ventilation with the lowest effective pressures if ventilatory support is required. Absence of an external wound does not exclude serious blast injury, and rapid transfer is necessary.

Reference: NHS England, Clinical guidelines for major incidents and mass casualty events: https://www.england.nhs.uk/publication/clinical-guidelines-for-major-incidents-and-mass-casualty-events/