Be prepared to provide care for MWDs exposed to bomb blasts and other explosions. Recognize that blast injuries may be subtle or occult for days, with MWDs appearing stable on initial evaluation. Figure 43 provides the recommended general approach to assessing MWDs exposed to blast.
Mechanisms
Blasts produce injury through primary effects of the blast overpressure wave, secondary injury due to penetrating objects displaced by the explosion impacting victims, tertiary injury due to victims physically being displaced into objects, and quaternary injury due to complications resulting from any combination of injury from primary, secondary, or tertiary injuries or unrelated to these mechanisms.
Initial Management
- Generally, the approach to blast-injured MWDs is the same as for any other type of trauma – FOCUS on life-threatening problems first, followed by targeted support based on findings, with emphasis on a detailed secondary evaluation and care as needed once the patient is stabilized.
- During initial care, focus on those types of life-threatening injuries commonly seen with blasts, especially respiratory distress due to airway obstruction or trauma, pneumothorax, pulmonary contusions, and hemothorax; traumatic amputations or serious bleeding; hemoperitoneum; CNS trauma; air embolism; and shock.
- While tympanic membrane (TM) rupture in and of itself is a minor injury, experience suggests that it is a marker of more severe systemic injury, and patients with TM rupture should be observed carefully for signs suggesting the development of other injuries.2-3 The absence of TM rupture, however, does not exclude potentially life-threatening internal injuries, based on recent data from humans exposed to blasts.3
- Recognize delayed onset of clinical signs. Many injuries from blasts may not manifest for many hours, to include pulmonary contusions, “blast lung,” concussions and mild TBI, and bowel hemorrhage with perforation and peritonitis. Serial monitoring is critical to detect early signs of impending decompensation due to these delayed problems. Any MWD exposed to blast should be evacuated to a veterinary facility as soon as possible for detailed evaluation and observation. If evacuation is not possible or is delayed, hospitalize in the MTF for 12-24 hours for close observation.
Figure 43. General Approach to Military Working Dogs Exposed to Blasts