Fast Five Quiz: Are You Prepared to Confront Firework-Related Injuries?

Richard H. Sinert, DO


June 30, 2015

Limited data prevent establishing the optimal duration of observation. Consider the following guidelines:

Persons who are exposed to open-space explosions and who have no apparent significant injury and normal vital signs, as well as unremarkable lung and abdominal examinations, generally can be discharged after 4 hours of observation. Return instructions should include shortness of breath, abdominal pain, vomiting, or other symptoms.

Persons exposed to significant closed-space explosions or in-water explosions, and those who incur tympanic membrane rupture, are at higher risk for delayed complications. All such patients should have chest radiography, and selected patients should have imaging of other organs. Even if no injury is identified, these patients should receive more intensive observation over a longer period. Motivated, reliable, and completely asymptomatic patients may be sent home after 4 hours of observation.

Admit to the hospital all patients with significant burns, suspected air embolism, radiation or water pollution contamination, abnormal vital signs, abnormal lung examination findings, clinical or radiographic evidence of pulmonary contusion or pneumothorax, abdominal pain, vomiting, evidence of renal contusion/hypoxia, or penetrating injuries to the thorax, abdomen, neck, or cranial cavity.

For more about the inpatient care of patients with blast injuries, read here.

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