Blast Injuries and Landmines Travelling positive pressure wave C. - PDF document

Explosive blast injuries Blast Injuries and Landmines Travelling positive pressure wave C. Giannou Hat Yai July 2012 Negative phase Blast injury: types � Primary: direct pressure effects � tympanum, blast lung, intestine � Secondary: missile wounds � bomb casing or contents � secondary missiles: stones, bricks, glass � Tertiary: blast wind � total body disintegration � traumatic amputation, evisceration � blunt injury � Quaternary: miscellaneous � burns, asphyxia, dust or gas inhalation 1

Different types of mines Different types of mines � Anti-tank mines � blast effect: blast injury � fragments: penetrating injury � fire: burns � blunt injury � Antipersonnel mines � blast type � fragmentation type � Lethal remnants of war ATM � UXO � cluster munitions Patterns of APM Injury Blast mine � Pattern 1 � Blast mine amputation � Pattern 2 � Fragmentation mine � Pattern 3 � Manipulation of mine 2

Blast mine Blast mine on the ground Blast effect on foot: Blast effect on foot: Small amount of explosive; pattern 1 injury Small amount of explosive Blast effect on foot: Blast effect on foot: Small amount of explosive Small amount of explosive 3

Blast effect on foot: Blast effect on leg: Small amount of explosive blast wave thrombosis Blast effect on leg: Blast effect on leg: blast wave thrombosis blast wave thrombosis Blast effect on leg: Blast effect on leg: blast wave thrombosis Larger amount of explosive; pattern 1 injury 4

Blast effect on leg: Blast effect on leg: pattern 1 injury pattern 1 injury Blast effect on leg: Blast effect on leg: pattern 1 injury pattern 1 injury Blast effect on leg: Blast effect: pattern 1 injury Pattern 1 injury; notice wounds of other limb and genitalia 5

Blast effect: Blast effect: Pattern 1 injury …. and of contralateral arm Small body, big amount of explosive Directional fragmentation mine Fragmentation mine Fragmentation mine: Bounding fragmentation mine pattern 2 injury; at a short distance 6

Fragmentation mine: Complex injury: pattern 2 injury; at a great distance Blast, fragments and burn Complex injury: Complex injury: Blast, fragments and burn Blast, fragments and burn PFM mine: pattern 3 injury PFM mine Manipulation of mine 7

PFM mine: pattern 3 injury Amputations: few basic rules Manipulation of mine � Function ….. function ….. function � Upper limb: as long as possible � Lower limb: support body weight � good muscle cover of stump: vastus medialis, medial gastrocnemius � non-adherent non-painful scar: bevelled tibia � proper length for stability: cut fibula 2 cm shorter than tibia � neuroma: prevent Blunt injury Anti-tank Mines 8

The victims: Penetration of the armour if you are lucky … The victims: someone will give you a prosthesis. learning … … together … to play … 9

Rehabilitation and Reintegration unless you prefer volleyball. 10