The quinary pattern of blast injury

Authors

  • Yoram Kluger, MD, FACS
  • Adi Nimrod, MD
  • Philippe Biderman, MD
  • Ami Mayo, MD
  • Patric Sorkin, MD

DOI:

https://doi.org/10.5055/jem.2006.0009

Keywords:

terrorism, blast injury, hyperinflammation

Abstract

Objective: Bombing is the primary weapon of global terrorism, and it results in a complicated, multidimensional injury pattern. It induces bodily injuries through the well-documented primary, secondary, tertiary, and quaternary mechanisms of blast. Their effects dictate special medical concern and timely implementation of diagnostic and management strategies. Our objective is to report on new clinical observations of patients admitted to the Tel Aviv Medical Center following a recent terrorist bombing.
Results: The explosion injured 27 patients and three died. Four survivors, who had been in close proximity to the explosion as indicated by their eardrum perforation and additional blast injuries, were exposed to the blast wave. They exhibited a unique and immediate hyperinflammatory state, two upon admission to the intensive care unit and two during surgery. This hyperinflammatory state was manifested by hyperpyrexia, sweating, low central venous pressure, and positive fluid balance. This state did not correlate with the complexity of injuries sustained by any of the 67 patients admitted to the intensive care unit after previous bombings.
Conclusion: The patients’ hyperinflammatory behavior, unrelated to their injury complex and severity of trauma, indicates a new injury pattern in explosions, termed the quinary blast injury pattern. Unconventional materials used in the manufacture of the explosive can partly explain the observed early hyperinflammatory state. Medical personnel caring for blast victims should be aware of this new type of bombing injury.

Author Biographies

Yoram Kluger, MD, FACS

The Department of Surgery, Rambam Medical Center, Rappaport School of Medicine, Technion, Haifa, Israel.

Adi Nimrod, MD

The Intensive Care Unit, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

Philippe Biderman, MD

The Intensive Care Unit, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

Ami Mayo, MD

The Department of Surgery, Rambam Medical Center, Rappaport School of Medicine, Technion, Haifa, Israel.

Patric Sorkin, MD

The Intensive Care Unit, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

References

Cernak I, Savic J, Ignjatovic D, et al.: Blast injury from explosive munitions. J Trauma. 1999; 47: 96-103.

Peleg K, Givon A, Moskowitz J: Trauma in Israel: Data from The National Trauma Registry. Israel National Center for Trauma and Emergency Medicine Research. Jerusalem, Israel: Trauma and Emergency Medicine Research Unit, The Gertner Institute for Health Policy Research, Israel Ministry of Health. Publication 60001, 2000. [in Hebrew]

Mellor SG, Cooper GJ: Analysis of 828 servicemen killed or injured by explosion in Northern Ireland 1970-84: the Hostile Action Casualty System. Br J Surg. 1989; 76: 1006-1010.

Kluger Y: Bomb explosions in acts of terrorism—detonation, wound ballistics, triage and medical concerns. Isr Med Assoc J. 2003; 5: 235-240.

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Published

01/01/2006

How to Cite

Kluger, MD, FACS, Y., A. Nimrod, MD, P. Biderman, MD, A. Mayo, MD, and P. Sorkin, MD. “The Quinary Pattern of Blast Injury”. Journal of Emergency Management, vol. 4, no. 1, Jan. 2006, pp. 51-55, doi:10.5055/jem.2006.0009.