Putting the 'having a blast' in blast injuries; various incendiaries

Was never too sure how it was said- 'ringing in the new year' or 'reining in the new year' either way the idea is the same. Little colorful tents pop up at your grocery store, arguments over what makes a firework illegal vs legal, it's that time of the year! Or the end of it I suppose. 

So on the topic of that special time of the year that lighting off explosives in residential zones is considered normal- let's talk about burns and blast injuries. 

  Blast injuries come in several forms and several phases- there being specifically 5 phases, if one doesn't get you maybe the next will. Blast injuries can be from direct or indirect exposure to explosives, and some incendiaries due to high heat. As previously mentioned there are different phases, those being primary, secondary, tertiary, quaternary, and quinary. 

   Primary blast injuries are lesser thought of when it comes to injuries from explosions since they mainly present internally. Primary injuries are caused from the first stage of the explosion, as things begin to explode pressure displaces- creating high pressurization and blast overpressure. This can result in lung trauma, ear damage, abdominal hemorrhage/perforation, rupture of the eye, mild TBI, among potential vessel issues. Think anything hollow in your body- lung issues being the most common as they rely on positive and negative pressure to function. This makes breathing difficulty a worry for blast injury patients.

   Next up are secondary blasts, this is the generally more well thought about portion of explosions. As pressure changes fragments and debris are thrown towards anything in it's way. This causes blunt force and penetrating injuries as debris either collides or penetrates into or through the body. As always, do not remove any objects from the body UNLESS they hinder CPR/resuscitative efforts. This is because a foreign object could be tapering or compressing a bleed, instead stabilize the object to the best of your ability and place patient in position of comfort.

   Then you have tertiary blast injuries, one of the more dramatic ones that comes to mind. As pressure gradients continue to change the body is thrown due to the force generated. These tend to be blunt force injuries that you would achieve from a nasty fall or car crash. This doesn't rule out that penetrating factors can exist in environment such as getting thrown into a cactus. This is generally more associated with common blunt mechanism injuries, such as bone fractures, traumatic amputations, crush injuries, and closed or open brain injuries in addition to possible vessel ruptures. Bone fractures being one of the easiest to handle, simply splint or sling a broken extremity, spinal precautions are important for these patients considering that they were thrown. Amputations follow the same general rule, if the limb is completely removed it generally will not bleed- however as the body compensates and ATP stores dip to lower levels the patient may begin to bleed again as the muscles can no longer splint the bleed- for this reason a tourniquet on an amputated extremity can be a smart idea but is not necessary as long as bleeding is controlled. Ideally if a limb can be found pair it with it's owner, keep it clean and keep it cold but do NOT put it DIRECTLY onto ice, as this will cellularly kill what's left of the limb. For crush injuries cardiac affects are more likely as muscle cell contents (mainly potassium and myoglobin) dump freely into the body. This is more common following long term crush injuries, for example bodies crushed under buildings. Generally after 4-6 hours crush syndrome can occur, meaning when the victim is freed this build up hits the body potentially causing organ failure and death. 

   Good ol' quaternary blast injuries! Now we consider what actually caused the explosion in the first place, heat, fluid, fuels, metals, gases, etc. Depending on the substance used patients can suffer burns, blindness, inhalation injuries, etc. Burns come in three genres (they're phasing out of degrees) superficial, partial thickness, and full thickness.

 Superficial thickness burns only burn the skins surface, usually they hurt like hell and are super red but not much else- some inflammation, redness, dryness but nothing to write home about. These are general cooking burns, where your reflexes save you from touching the stove for a little too long. These are generally treated with a burn gel or running the burn under cold water- because as the skin remains hot the burning process still continues. 

 Partial thickness is the next step here the epidermis and lower dermis are affected, just as before there is pain, redness, and swelling, but the real difference is that these present with blisters. Some partial thickness burns are less to be concerned about, some are more to be concerned about- but the general consensus is that the worry lies in size and bodily amount affected. 

 Full thickness, these are the bad ones, here the burn perforates into deep tissues, causing charring (white or black) these tend to be numb due to the nerves being burnt as expected by the depth. 

Caring for burns can be tricky. The worry usually surpasses the burn itself, as previously mentioned, cellular contents begin dumping in the body- specifically arrhythmia inducing potassium. In addition burns patients are more likely to suffer from hypothermia and become much more susceptible to infection. Cool burns down, keep them clean, and keep the patient warm (but not too warm), monitor for cardiac and airway issues, as if skin is burned usually the respiratory tract is affected as well.

   Quinary blast injuries are often overlooked, these are generally the biological and environmental implications. This is more for radioactive, chemical, or bacterial attacks, however more generally overlooked are the heavy metals used to color fireworks, which via burns or general contact can seep into the skin. 

Well, that's the simple stupid guide on blast injuries and burns, hopefully you'll never have to use any of that now. Have a safe new year's eve and a great new year!