Primary Blast Injury
-impact of the overpressurization wave
-gas filled strucutres are most susceptible
Seconadry
Results flying debris and bomb fragments
-any body part may be affected
-penetrating or bunt injuries
-eye penetration
Tertiary
-results form individual being frown by the blast wind
-any body part affected
-fractures and traumatic amputation
-closed and open brain injury
Quaternary
All explosion rated injure,s illness or disease not due to priamry, secondary, or tertiary mechanisms includes exacerbation or complicaitons of exiting conditions
-burns
-crush injuries
-closed or open brain injury
-asthma, COPD
-angina
-hyperglycemia
-HTN
Calcium
-muscular contraction
-myocardial contraction (vascular smooth muscle)
-platelet activation
-coagulation cascade
Hypocalcemia
-hemorrhage is the major cause
-exacerbated by blood transfusion
-suppression of cardiac contractility and decrease in CO
-decreased vasomotor / vascular resistance -> reduced efficacy of compensatory mechanism
-decreased coagulation cascade activation
-decreased platelet function/ stabilization
What does citrate do?
-it is located in blood, usually blood that is kept on the shelf after blood transfusion to make calcium in active
-when you introduce it back into the body, that is no deficient in calcium (any excess citrate will bind to calcium in the body so it can make the hypocalcemia worse)
Acidosis
-hypovolemia/ decrease/ CO/ periphearl vasoconstriciton ->poor perfusion In tissue -> hypoxemia -> anaerobic metabolism -> lactic acid production -> decrease pH
What does severe acidosis lead to ?
- Suppression of cardiac function and decrease in CO
2.decreased effectiveness of catecholamines - Induced of coagulopathy (decreased clotting in mass hemorrhage)
Hypothermia leads to
-decreased energy due to inefficent/ low production/ anerobic state
-temperature depdent inhibiton of coagulation cascade -> marked increased in bleeding
-decreased clotting
-decreased liver metabolism of citriate -> increased bound calcium -> further hypocalcemia
