Goh S H
Accident & Emergency Department, Changi General Hospital, Singapore.
Singapore Med J. 2009 Jan;50(1):101-6.
Bomb blast injuries are no longer confined to battlefields. With the ever present threat of terrorism, we should always be prepared for bomb blasts. Bomb blast injuries tend to affect air-containing organs more, as the blast wave tends to exert a shearing force on air-tissue interfaces. Commonly-injured organs include the tympanic membranes, the sinuses, the lungs and the bowel. Of these, blast lung injury is the most challenging to treat. The clinical picture is a mix of acute respiratory distress syndrome and air embolism, and the institution of positive pressure ventilation in the presence of low venous pressures could cause systemic arterial air embolism. The presence of a tympanic membrane perforation is not a reliable indicator of the presence of a blast injury in the other air-containing organs elsewhere. Radiological imaging of the head, chest and abdomen help with the early identification of blast lung injury, head injury, abdominal injury, eye and sinus injuries, as well as any penetration by foreign bodies. In addition, it must be borne in mind that bomb blasts could also be used to disperse radiological and chemical agents.
炸弹爆炸伤不再局限于战场。鉴于恐怖主义威胁始终存在，我们应时刻为炸弹爆炸做好准备。炸弹爆炸伤往往更易影响含气器官，因为爆炸波倾向于在气 - 组织界面施加剪切力。常见的受伤器官包括鼓膜、鼻窦、肺和肠道。其中，爆震性肺损伤的治疗最具挑战性。临床表现为急性呼吸窘迫综合征和气栓的混合症状，在静脉压较低的情况下进行正压通气可能会导致全身性动脉气栓。鼓膜穿孔的存在并非其他部位含气器官存在爆炸伤的可靠指标。头部、胸部和腹部的放射影像学检查有助于早期识别爆震性肺损伤、头部损伤、腹部损伤、眼和鼻窦损伤以及任何异物穿透情况。此外，必须牢记炸弹爆炸也可能被用于散布放射性和化学制剂。
