Pneumo/hemothorax: chest tube
CT, depending on findings:
Hemoptysis, dyspnea, or tachypnea?
Evidence of penetrating injury?
Pneumo/hemothorax: chest tube
Preform secondary survey
Evidence of penetrating injury?
Follow ATLS guidelines
Observe 4-6 hrs. If no deterioration, consider discharge.
Blast Lung Injury (BLI)
Assessing for Other Primary Blast Injuries
GI: diagnosis based on repeat clinical exam; radiologic studies including abdominal films, ultrasound, and CT scans are insensitive in the absence of intestinal perforation.
Brain: headache, tinnitus, hypersensitivity to noise, amnesia (retrograde and anterograde), symptoms commonly associated with PTSD
MSK: radiographs important not only to detect fractures but to detect radio-opaque foreign material and articular involvement.
Perform 2º survey
Penetrating Injury
Head: maintain cerebral perfusion & oxygenation. Seizure prophylaxis. Monitor and control ICP. If evidence of increased ICP, consult Neurosurgery for possible decompressive craniectomy.
Chest: Consider angiography, bronchoscopy, or esophagoscopy.
Abdomen: FOBT, UA & micro.
Extremities: Assess neurovascular function. Monitor for compartment syndrome.
General Guidelines