Complications
The following complications can ensue in patients presenting to the ED with blast injury:
1 – Mortality following blast injury has a bimodal distribution, with most fatalities being immediate at the scene of the explosion.
Mortality in patients surviving to hospital treatment is higher than in other forms of trauma, but nonetheless remains low.
All patients, no matter how critically ill, should be treated aggressively [12].
2 – Patients may develop long-term hearing deficit following exposure to blast.
A rare but important complication of perforation of the tympanic membrane is the development of cholesteatoma [1].
Epithelial cells are implanted into the middle ear by the traumatic insult. Cellular growth is promoted and the resultant tumour is invasive with the potential to erode bony structures.
3 – Follow-up of small numbers of patients admitted with blast lung injury has demonstrated that long-term respiratory disability is uncommon and that most will have normal lung function one year after injury [12].
4 – It has been estimated that up to 50% of soldiers injured in combat may return with some degree of traumatic brain injury (all causes), and up to a third of sufferers of even mild traumatic brain injury develop chronic symptoms.
There may be long-term neurological, cognitive, behavioural and psychiatric complications [14] with the potential to cause permanent disability or even death.
Common symptoms include amnesia, poor concentration, language impairment, motor slowing and personality change. Its essential that these symptoms are recognised and, where appropriate, support offered.
The psychological consequences of being involved in a blast are significant and can be disabling.
Crush syndrome, rhabdomyolysis and acute renal failure may occur after blast injuries.