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Abdominal Pain
Abdominal Pain

Abdominal Pain

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Decision

Severe abdominal pain?

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No → Administer pain control; Place in observation (Class II)

Background

The gastrointestinal system is also susceptible to primary blast injury; however, these injuries are more commonly seen with underwater and confined-space explosions as a result of increased blast pressure and an extended positive-pressure phase. Injury to the alimentary tract was the most common intra-abdominal injury after terror-related blast injury. In a prospective study by Guy et al, 20 anesthetized rats were exposed to moderate blast overpressure; the colon and ileocecal regions were at greatest risk for perforation from implosion and inertial forces. Significant trauma and blood loss can occur in the abdomen without notable changes in patient’s hemodynamics or physical examination, making these injuries initially silent before developing into an acute abdomen.

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References

Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study, such as the type of study and the number of patients in the study is included in bold type following the references, where available. The most informative references cited in this paper, as determined by the authors, are noted by an asterisk (*) next to the number of the reference.

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  3. American College of Emergency Physicians. Bombings: Injury Patterns and Care. Accessed January 10, 2023. (Web-based course)
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  43. Ritenour AE, Wickley A, Ritenour JS, et al. Tympanic membrane perforation and hearing loss from blast overpressure in Operation Enduring Freedom and Operation Iraqi Freedom wounded. J Trauma. 2008;64(2 Suppl):S174-S178. (Retrospective; 436 patients)
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  45. Nunziato CA, Riley CJ, Johnson AE. How common are civilian blast injuries in the national trauma databank, and what are the most common mechanisms and characteristics of associated injuries? Clin Orthop Relat Res. 2021;479(4):683-691. (Retrospective; 968,834 patients) DOI: 10.1097/CORR.0000000000001642
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  47. Hamele M, Poss WB, Sweney J. Disaster preparedness, pediatric considerations in primary blast injury, chemical, and biological terrorism. World J Crit Care Med. 2014;3(1):15-23. (Review)
  48. Tovar MA, Pilkington RA, Goodwin T, et al. Pediatric blast trauma: a systematic review and meta-analysis of factors associated with mortality and description of injury profiles. Prehosp Disaster Med. 2022;37(4):492-501. (Systematic review and meta-analysis; 38 articles, 222,638 injuries)
  49. Harrison CD, Bebarta VS, Grant GA. Tympanic membrane perforation after combat blast exposure in Iraq: a poor biomarker of primary blast injury. J Trauma. 2009;67(1):210-211. (Prospective; 167 patients)
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  52. Schreiber MA, Meier EN, Tisherman SA, et al. A controlled resuscitation strategy is feasible and safe in hypotensive trauma patients: results of a prospective randomized pilot trial. J Trauma Acute Care Surg. 2015;78(4):687-695. (Randomized controlled trial; 192 patients))
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  56. Finnegan AP, Cumming PA, Piper ME. Critical incident stress debriefing following the terrorist bombing at Army Headquarters Northern Ireland. J R Army Med Corps. 1998;144(1):5-10. (Prospective; 407 patients)
  57. Leibovici D, Gofrit ON, Shapira SC. Eardrum perforation in explosion survivors: is it a marker of pulmonary blast injury? Ann Emerg Med. 1999;34(2):168-172. (Prospective; 647 patients)
  58. Ashkenazi I, Olsha O, Turegano-Fuéntes F, et al. Tympanic membrane perforation impact on severity of injury and resource use in victims of explosion. Eur J Trauma Emerg Surg. 2017;43(5):623-626. (Retrospective review)

Severe Abdominal Pain
Severe Abdominal Pain

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