A powerful bomb exploded outside Delhi High Court gate number 5 on Wednesday morning. The blast took place at around 10.15 am. It left 11 people dead and more than 100 injured. This is the second such incident at the High Court this year.
Half of all early casualties seek medical care over first hour. To know the total number of casualties, double this number after one hour. This formula is often used by the media to predict the tolls. It is also useful to predict demand for care and resource needs.
The most severely injured arrive after the less injured who self–transport to the closest hospitals, so always expect upside down triage.
It is important that we as doctors know how bomb blast cause injuries in order to tackle the repercussions of bomb blasts. Bomb blast injuries can be categorized into four types:
• Primary blast injuries are a direct result of the impact of the over pressurized blast wave on the body. It involves injuries to the hollow gas–filled organs like the lungs, ear drum or intestines leading to their rupture.
• Secondary blast injuries occur due to flying debris and bomb fragments causing penetration or penetrating injuries to organs such as eyes.
• Tertiary blast injuries occur when individuals are thrown by the blast wind leading to fractures due to the fall.
• Quaternary blast injuries are due to direct effect of burn or crush injuries.
The most important aspect is not to waste energies and resources on patients with non-serious injuries.
Look for eardrum rupture and signs of respiratory imbalance. Their absence indicates a non–serious injury.
• If the ear drums are intact, the patient can be discharged with first–aid treatment.
• If ear drum is ruptured, immediately do an X–ray chest. Keep the patient under observation for eight hours as primary blast injuries may have a delayed presentation.
Hence, otoscopic ear exam can be used as a screening procedure for triage. Decreased oxygen saturation on pulse oximetry signals early blast lung injury, even before symptoms become apparent.
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