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WARFARE INJURIESBLAST INJURIESANDCRITICAL CARE

Dr Shahzad Alam ShahAssistant Prof. Laparoscopic SurgeryFJMC/SGRHL

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Blast Injuries

A blast injury is a complex type of physicaltrauma resulting from direct or indirectexposure to an explosion

http://en.wikipedia.org/wiki/Trauma_(medicine)http://en.wikipedia.org/wiki/Trauma_(medicine)http://en.wikipedia.org/wiki/Explosionhttp://en.wikipedia.org/wiki/Explosionhttp://en.wikipedia.org/wiki/Trauma_(medicine)http://en.wikipedia.org/wiki/Trauma_(medicine)

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http://upload.wikimedia.org/wikipedia/commons/2/26/Shotgun_wound.JPG

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PRIMARY INJURIESPrimary injuries are caused by blast

overpressure waves, or shock waves

http://en.wikipedia.org/wiki/Overpressurehttp://en.wikipedia.org/wiki/Shock_wavehttp://en.wikipedia.org/wiki/Shock_wavehttp://en.wikipedia.org/wiki/Overpressure

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http://upload.wikimedia.org/wikipedia/commons/e/ea/Pulmonary_contusion_CT_arrow.jpg

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SECONDARY INJURIES

Secondary injuries are due to bomb fragmentsand other objects propelled by the explosion

http://en.wikipedia.org/wiki/Bombhttp://en.wikipedia.org/wiki/Bomb

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Blast Injury

MechanismThe magnitude of damage due the blast wave

is dependent on:1) the peak of the initial positive pressure wave2) the duration of the overpressure;3) the medium in which it explodes;4) the distance from the incident blast wave; and5) the degree of focusing due to a confined area orwalls.

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CRITICAL CARE

Intensive-care medicine or critical-caremedicine is a branch of medicine concernedwith the provision of life support or organsupport systems in patients who are criticallyill and who usually require intensivemonitoring.

http://en.wikipedia.org/wiki/Life_supporthttp://en.wikipedia.org/wiki/Life_support

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Florence Nightingale

http://upload.wikimedia.org/wikipedia/commons/4/40/Florence_Nightingale_1920_reproduction.jpg

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OverviewPatients requiring intensive care may requiresupport for

hemodynamic instabilityairway or respiratory compromiseacute renal failure ,potentially lethal cardiac arrhythmias ,multiple organ failure , more commonly referredto now as multiple organ dysfunction syndrome .Intensive monitoring after major surgery

http://en.wikipedia.org/wiki/Hemodynamichttp://en.wikipedia.org/wiki/Acute_renal_failurehttp://en.wikipedia.org/wiki/Cardiac_arrhythmiashttp://en.wikipedia.org/wiki/Multiple_organ_failurehttp://en.wikipedia.org/wiki/Multiple_organ_dysfunction_syndromehttp://en.wikipedia.org/wiki/Multiple_organ_dysfunction_syndromehttp://en.wikipedia.org/wiki/Multiple_organ_failurehttp://en.wikipedia.org/wiki/Cardiac_arrhythmiashttp://en.wikipedia.org/wiki/Acute_renal_failurehttp://en.wikipedia.org/wiki/Hemodynamic

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Intensive Care Unit

http://upload.wikimedia.org/wikipedia/commons/7/78/Intensivstation_(01)_2007-03-03.jpg

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Organ systems

Intensive care usually takes a system by system approach totreatment, rather than the SOAP (subjective, objective, analysis,plan) approach of high dependency care

The nine key IC systems are (alphabetically): cardiovascular system ,central nervous system ,endocrine system ,gastro-intestinal tract hematology ,microbiology (including sepsis status),renal (and metabolic),respiratory system

http://en.wikipedia.org/wiki/Subjective_Objective_Assessment_Planhttp://en.wikipedia.org/wiki/Cardiovascular_systemhttp://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Endocrine_systemhttp://en.wikipedia.org/wiki/Gastro-intestinal_tracthttp://en.wikipedia.org/wiki/Hematologyhttp://en.wikipedia.org/wiki/Microbiologyhttp://en.wikipedia.org/wiki/Renalhttp://en.wikipedia.org/wiki/Respiratory_systemhttp://en.wikipedia.org/wiki/Respiratory_systemhttp://en.wikipedia.org/wiki/Renalhttp://en.wikipedia.org/wiki/Microbiologyhttp://en.wikipedia.org/wiki/Hematologyhttp://en.wikipedia.org/wiki/Gastro-intestinal_tracthttp://en.wikipedia.org/wiki/Gastro-intestinal_tracthttp://en.wikipedia.org/wiki/Gastro-intestinal_tracthttp://en.wikipedia.org/wiki/Endocrine_systemhttp://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Cardiovascular_systemhttp://en.wikipedia.org/wiki/Subjective_Objective_Assessment_Plan

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Oval Silicon Resuscitator

for manual ventilation

http://upload.wikimedia.org/wikipedia/commons/a/ab/Ballon_ventilation_1.jpg

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Endotracheal Tube

http://upload.wikimedia.org/wikipedia/commons/5/5d/Endotracheal_tube_colored.pnghttp://upload.wikimedia.org/wikipedia/commons/1/19/Sondeintubation.jpg

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Nasogastric Tube

http://upload.wikimedia.org/wikipedia/commons/a/a2/Kendall_stomach_tube_Fr18.jpg

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Intravenous Fluid Therapy

Blood Transfusions

http://en.wikipedia.org/wiki/File:Infuuszakjes.jpg

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Equipment and systems

Common equipment in an intensive-careunit (ICU) includes

Mechanical ventilation to assist breathing through anEndotracheal tube Intravenous linesNasogastric tubes ,Suction pumps,Drains andCatheters ;Drugs

http://en.wikipedia.org/wiki/Mechanical_ventilationhttp://en.wikipedia.org/wiki/Tracheal_intubationhttp://en.wikipedia.org/wiki/Intravenoushttp://en.wikipedia.org/wiki/Nasogastric_tubehttp://en.wikipedia.org/wiki/Cathetershttp://en.wikipedia.org/wiki/Pharmacologyhttp://en.wikipedia.org/wiki/Pharmacologyhttp://en.wikipedia.org/wiki/Cathetershttp://en.wikipedia.org/wiki/Nasogastric_tubehttp://en.wikipedia.org/wiki/Nasogastric_tubehttp://en.wikipedia.org/wiki/Nasogastric_tubehttp://en.wikipedia.org/wiki/Intravenoushttp://en.wikipedia.org/wiki/Tracheal_intubationhttp://en.wikipedia.org/wiki/Tracheal_intubationhttp://en.wikipedia.org/wiki/Tracheal_intubationhttp://en.wikipedia.org/wiki/Mechanical_ventilationhttp://en.wikipedia.org/wiki/Mechanical_ventilation

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Intensive care unit

An intensive care unit (ICU), critical care unit (CCU), intensive therapy unit , or intensive

treatment unit (ITU) is a specializeddepartment in a hospital that provides intensive-care medicine .

http://en.wikipedia.org/wiki/Hospitalhttp://en.wikipedia.org/wiki/Intensive-care_medicinehttp://en.wikipedia.org/wiki/Intensive-care_medicinehttp://en.wikipedia.org/wiki/Intensive-care_medicinehttp://en.wikipedia.org/wiki/Intensive-care_medicinehttp://en.wikipedia.org/wiki/Intensive-care_medicinehttp://en.wikipedia.org/wiki/Hospital

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TYPES

Specialized types of ICUs include:Neonatal intensive-care unit (NICU)Pediatric intensive-care unit (PICU)Coronary care unit (CCU)Medical Surgical intensive-care unit ( MSICU)Surgical intensive-care unit ( SICU)

Trauma Intensive care Unit ( TICU)Mobile Intensive Care Unit ( MICU)

http://en.wikipedia.org/wiki/Neonatal_intensive-care_unithttp://en.wikipedia.org/wiki/Pediatric_intensive-care_unithttp://en.wikipedia.org/wiki/Coronary_care_unithttp://en.wikipedia.org/wiki/Coronary_care_unithttp://en.wikipedia.org/wiki/Pediatric_intensive-care_unithttp://en.wikipedia.org/wiki/Pediatric_intensive-care_unithttp://en.wikipedia.org/wiki/Pediatric_intensive-care_unithttp://en.wikipedia.org/wiki/Neonatal_intensive-care_unithttp://en.wikipedia.org/wiki/Neonatal_intensive-care_unithttp://en.wikipedia.org/wiki/Neonatal_intensive-care_unit

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Pattern of Injury