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Simulation Debriefing

Simulation Debriefing. Simulation Debriefing. Blast Trauma Scenario. Blast Trauma Scenario. Blast Injuries. Sudden force Rapid acceleration High peak velocity “Shock waves” stretch & tear soft tissues, shatter bones. Injuries from Explosions.

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Simulation Debriefing

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  1. Simulation Debriefing Simulation Debriefing Blast Trauma Scenario Blast Trauma Scenario

  2. Blast Injuries • Sudden force • Rapid acceleration • High peak velocity • “Shock waves” stretch & tear soft tissues, shatter bones

  3. Injuries from Explosions • Blunt trauma (blast force, flying objects, falls) • Penetrating trauma • Barotrauma

  4. Secondary Injuries • Crush injuries • Amputations • Burns • Toxic inhalations • Contaminants (chemical & radiation)

  5. Primary Blast Injury • Hemotympanum or rupture • Hearing loss

  6. Primary Blast Injury • Pulmonary lacerations • Hemo- or pneumothorax • Bronchopleural fistulas • Pulmonary contusions • Systemic arterial air embolism • Distal ischemia • Massive hemoptysis

  7. Primary Blast Injury • GI hemorrhage • Gastrointestinal ischemia • Transmural gastric & bowel tears • Peritonitis • May be occult

  8. Primary Blast Injury • Shattering of bone

  9. Treatment Caveats • Stop exanguinating hemorrhage. • Pneumothorax is common. • Pulmonary venous air embolism is possible. • PPV worsens both. • Exertion may worsen blast lung injury.

  10. Treatment Caveats • Shock & burn injuries require large volumes of IV fluids. • Continued fluid resuscitation for burn injury: ~23% BSA x 70 kg x 2 cc/kg = 3220 cc One half in first 8 hrs = 1610 cc Rate per hour = 200 cc

  11. Treatment Caveats • Rapid infusion of IV crystalloids may worsen pulmonary contusions. • Use small boluses; reevaluate frequently.

  12. Treatment Caveats • Consider crush injury, rhabdomyolysis, & compartment syndrome if entrapment. • Consider toxic gas inhalation from fires. • Consider deliberate radiation or chemical contamination. • Otherwise, follow standard management strategy for blunt & penetrating trauma.

  13. Optimal Management Strategy • Setting affects strategy: Small community hospital with limited resources & staff • Extent of stabilization may vary.

  14. Optimal Management Strategy • See “Blast Trauma Simulation Skill Sets.” • Basic or advanced

  15. Credits Project funded by: Regional Bioterrorism Prepardedness Project Michigan Department of Community Health & Health Resources and Services Administration Project Director: William Fales, MD MSU/KCMS Simulation development: Richard Lammers, MD MSU/KCMS With technical assistance from: Stu Myers, BS, EMT-P Jason Schlautman, MD

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