Features of mine-explosive injury
Mine explosive wound
A mine-explosive wound is the result of a single-stage impact on the body of heterogeneous damaging factors of an explosive device (shock wave, gas-flame jet, mine fragments, etc.) with the involvement of organs and systems in the pathological process in various combinations.
This injury is fundamentally different from injuries due to transport, industrial or domestic damage and belongs to the category of gunshot wounds. The injury stands out for its severity, specificity of injuries and unfavorable course.
Improving the quality of prehospital care (rapid evacuation and early specialized surgical care) greatly affects the lethality of mine-explosive wounds, but does not exclude a large number of complications later.
A mine-explosive wound does not include a wound received only from shrapnel, since the main cause of complex pathological changes is, first of all, the impact of an explosive wave, which leads to explosive destruction of tissues or separation of limb segments.
Grenades and mines
When a projectile explodes in close proximity to a person or a contact detonation on an anti-personnel mine, the main destructive blow to the body is produced by a powerful wave of gaseous explosive detonation products, as well as a dense stream of fragments of the ammunition body.
Rapidly expanding explosive gases force the surrounding air to the sides, compressing it and forming an air shock wave. Depending on the power of the charge and proximity to the place of explosion, complete destruction or throwing of the body, damage to internal organs, detachment of limbs, and tissue rupture can occur.
It is precisely because of the difference in the mechanisms of inflicting injury to the body that there is a defensive hand grenade (F-1) with an explosive mass of 60 grams, but giving more fragments, and a remote hand grenade (RGD-5) with an explosive mass of 110 grams. We send a special hello to TOS-1.
The nature of damage to internal organs from an air shock wave:
1. Hearing damage. Rupture of the eardrums, hearing loss, vestibular disorders.
2. Damage (contusion) of the heart and lungs. It occurs due to shock compression between the spinal column, the chest wall moving inward and the diaphragm rising up due to the ram action of the abdominal organs, squeezed through the abdominal wall by a compression wave.
3. Damage to the abdominal organs. Despite the fact that such damage is relatively rare, the resulting internal bleeding or perforation of the gastrointestinal tract leads to death without prompt medical attention.
Secondary blast effects include shrapnel, explosive device parts, special weapons, and secondary projectiles such as rocks. Wounds accompanied by damage to cavities, blood vessels and vital organs have the greatest clinical significance.
The tertiary effects of the impact of the air-shock wave include the propelling effect. Under the influence of excess pressure and wind flow, the human body can be thrown several meters away. Injuries occur either at the stage of acceleration or landing. The effect of the propelling action depends not only on the power of the charge, but also on the area of the human body.
Features of the defeat of the crews of armored vehicles
The nature and severity of injuries during armored action depend on the penetration of the sides or bottom of armored vehicles.
When the bottom of armored vehicles is not penetrated, crew members usually experience combined injuries of the hearing and vestibular apparatus, lower extremities, spine, skull, as well as bruises of internal organs.
When breaking through the bottom of armored vehicles, mechanical damage, shrapnel wounds, burns and toxic damage are added to this set.
If the armor is not penetrated, the impact accumulations of the support (bottom, seat) and walls of the habitable compartments act as the leading damaging factor. An important role in the defeat of the crew can be played by the generated air shock wave, which is repeatedly reflected from the walls of the habitable compartments, as well as strong noise, which causes injury to the hearing organs. The most vulnerable to such shocks are internal organs with weak fixation: the heart, lungs, abdominal organs. In addition, due to the peculiarities in the speed of propagation of strain waves through dense tissues and structures, blood vessels, the brain and spinal cord suffer.
When armor is broken, a person is exposed to the following factors:
1. Air shock wave.
2. Primary and secondary fragments.
3. High-velocity and high-temperature gas flows and molten metal particles.
4. Flame.
5. Toxic products of explosion and combustion.
Most often, when the armor of the crew is broken, the bones of the limbs, the spine, the brain, the heart, lungs, blood vessels and abdominal organs are damaged. In addition, burns and poisoning by gases generated during the explosion are observed.
Consequences of mine-explosive injuries
In response to a mine-explosive injury, the body uses general and local defensive reactions similar to those in a gunshot wound, and they differ only in intensity.
Nevertheless, mine-explosive injuries have their own characteristics:
1. Acute massive blood loss. The volume of blood loss during MVR in 35% of the wounded is 1,0-1,5 l, in 50% - 1,5-2,0 l, in 15% - more than 2,0 l.
2. Bruises of the heart. They occur in 17% of cases and are characterized by focal hemorrhages in the myocardium and epicardium, circulatory disorders with the formation of foci of necrosis and dystrophic disorders.
3. Pulmonary contusions. They occur in 18% of cases and are expressed in ruptures of the visceral pleura and lung tissue. Accompanied by focal hemorrhages and collapse of lung tissue.
4. The combined nature of the injury. Most often, with a mine-explosive wound, the head is damaged (72%), in most cases this is accompanied by mild and moderate craniocerebral injuries. At the same time, 29% of the wounded have bruises of the brain, 5% have injuries to the face and eyes, 7% have penetrating shrapnel wounds, and in 3,5% of cases compression of the brain develops.
In 49% of the wounded with mine-explosive wounds, the chest is damaged. In addition to bruising of the lungs and heart, half of the wounded have rib fractures, and 9% have penetrating chest wounds. In 40% of cases, chest injuries are accompanied by hemo- or pneumothorax. Abdominal injuries occur in 10% of the wounded. Closed injuries (42%) are mainly accompanied by damage to parenchymal organs (liver, spleen, kidneys), and hollow organs are more often damaged in shrapnel wounds.
In 26% of cases, limb segment avulsions are accompanied by open or closed fractures of the bones of the upper and lower extremities, in 7% of cases - by penetrating shrapnel wounds of the joints.
5. Early traumatic endotoxicosis, that is, poisoning by products of impaired metabolism, remnants of cellular and tissue structures, as well as destroyed protein molecules. Endogenous intoxication syndrome is one of the most difficult problems in intensive care.
6. Combined wounds.
In tactical terms, burns of the face and upper respiratory tract are of great importance, since they are accompanied by acute respiratory failure. The role of respiratory poisoning increases significantly with explosions in confined spaces.
Conclusions
First of all, the wounded with mine-explosive and explosive injuries must be assisted to eliminate life-threatening consequences: bleeding and asphyxia.
In traumatic amputation, a tourniquet is applied to the stump, even if there is no bleeding. This is necessary for the prevention of endotoxicosis. It is allowed to apply a tourniquet above the place of separation, but given the stressful situation and the inability to control the presence of bleeding, it is better to apply the tourniquet proximally (as close to the body as possible, if the arm is on the shoulder, if the leg is on the thigh).
Next, the victim must be prepared for evacuation, as he needs qualified medical assistance. The sooner you can get the wounded to the doctors, the better.
Among other things, it is important to remember that inspection, mutual assistance and preparation for transportation are carried out only in the conditions of the so-called “yellow” zone, for example, shelter. Of course, it’s a pity for the little brother, especially if he screams, but you can’t rush to him headlong.
Thus, based on everything written, it must be understood that with a mine-explosive injury, damage can be hidden, and a person, being under the influence of compensatory functions of the body, will not give the impression of a wounded person. Now there are quite a lot of videos where the crew successfully leaves the damaged equipment, but not everyone is able to get away from it without visually having critical injuries, for example, traumatic amputation or severe bleeding.
Under ideal conditions, even if a person is brave and says that everything is in order, medical confirmation of his words is required.
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