Cardiovascular System
Acceleration-deceleration forces acting directly on the mediastinum may cause cardiac contusion [6].
Air embolism can affect the coronary arteries and result in myocardial ischaemia and infarction [1,6,14].
Animal studies have demonstrated that a vagally-mediated response to thoracic blast injury results in a prolonged period of bradycardia with hypotension in the presence of normal systemic vascular resistance, which may explain why some patients with significant blast injury may be hypotensive without evidence of haemorrhage [6,12].
In the ED
- Patients complain of chest pain, breathlessness, sweating and nausea
- ECG may reveal typical ischaemic changes or arrhythmia
- These patients should be managed initially with high-flow oxygen with expedient correction of any arrhythmia
- Nitrates are not indicated in the management of myocardial ischaemia due to systemic air embolism and thrombolytic agents should be avoided
- Hyperbaric oxygen therapy may be indicated