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Blast injuries are commonly thought of as incidents that occur in other countries, not here in the United States. The majority of clinicians are not prepared to deal with the devastation of a civilian blast incident and the resulting injury patterns. The author reviews expected injury patterns, triage decisions, and current therapies.
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Whether a bite or sting results in an anaphylactic reaction, impressive local effects, or a life-threatening systemic reaction, the emergency physician must be able to institute appropriate and effective treatment. Emergency physicians also must be able to recognize clinical envenomation patterns, since some critically ill patients may not be able to convey the details of the attack. Since all areas of the country are represented in the envenomation statistics, all emergency physicians should be familiar with identification and stabilization of envenomated patients and know what resources are available locally for further management of these often complicated patients.
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This article, the second of two parts, deals with the potentially disastrous situation in which either the patients airway presents a substantial challenge or standard intubation methods have failed.
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In a patient with a traumatic injury, airway management assumes an essential role to stabilization and survival of the patient, but often presents unique challenges not inherent in other types of patients.
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The ED physician and trauma surgeon must have evidence-based information on indications for emergency department thoracotomy that can be determined rapidly, easily accessible equipment, and the ability to recognize situations in which EDT clearly is not in the patients best interest.
