Which of the following is NOT typically sustained in the tertiary phase of blast injuries?

• A. Pulmonary barotrauma
• B. Hyperextension injuries
• C. Compression fractures of the spine
• D. Rib fractures

Answer: (D)

In blast injuries, injuries are grouped by mechanism and phase. Primary injuries come from the blast overpressure and most notably affect gas-filled organs like the lungs, causing pulmonary barotrauma. This kind of injury is tied to the immediate pressure pulse and is not a hallmark of the tertiary phase.

Tertiary injuries arise when the blast wind drives the body into surrounding objects, producing blunt trauma from acceleration and impact. From that mechanism, you typically see injuries such as hyperextension injuries of the spine and compression fractures of the spine, along with other blunt trauma to the chest and limbs. Rib fractures can occur with blunt chest trauma, but they are less characteristic of tertiary blast injuries than spinal injuries.

So, the finding not typically sustained in the tertiary phase is pulmonary barotrauma, which is associated with the primary phase rather than tertiary.