When assessing a patient who experienced a blast injury, it is important to remember that:

• A. Primary blast injuries are the most easily overlooked.
• B. Primary blast injuries are typically the most obvious.
• C. Solid organs usually rupture from the pressure wave.
• D. Secondary blast injuries are usually the least obvious.

Answer: (A)

The important idea is that primary blast injuries, caused by the overpressure of the explosion, are easy to miss. These injuries affect air-filled structures like the lungs, ears, and portions of the GI tract and often lack obvious external wounds. Because there may be little or no visible injury, a patient can appear deceptively well while critical damage to breathing, hearing, or abdominal organs remains hidden. So in blast assessments, you must actively look for signs of primary injuries even when the outside looks uninjured: listen to the lungs for contusion or pneumothorax, check for tympanic membrane rupture or hearing loss, and remain alert for abdominal pain, tenderness, or distension that might indicate bowel injury. This vigilance is crucial because secondary injuries from debris or shrapnel or tertiary injuries from the body being thrown can present with more apparent wounds, but the primary injuries require careful assessment to avoid missing life-threatening problems.