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Military Medicine Mar 2011Explosions can cause devastating injuries by various wounding mechanisms. Injuries due to the primary pressure wave are rarely life threatening and those that are lethal... (Review)
Review
Explosions can cause devastating injuries by various wounding mechanisms. Injuries due to the primary pressure wave are rarely life threatening and those that are lethal are uncommon. We reviewed the pathophysiology of blast-related injuries and their implications for management. There is much overlap in treatment of these wounds, and a detailed description is beyond the scope of this review. A brief summary of the initial surgical and nonsurgical management of blast injury that is useful for civilian and military clinicians is provided.
Topics: Abdominal Injuries; Blast Injuries; Brain Injuries; Crush Syndrome; Extremities; Humans; Lung Injury; Military Personnel; Multiple Trauma; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 21456353
DOI: 10.7205/milmed-d-10-00147 -
British Journal of Anaesthesia Feb 2022Injury scoring systems can be used for triaging, predicting morbidity and mortality, and prognosis in mass casualty incidents. Recent conflicts and civilian incidents... (Review)
Review
Injury scoring systems can be used for triaging, predicting morbidity and mortality, and prognosis in mass casualty incidents. Recent conflicts and civilian incidents have highlighted the unique nature of blast injuries, exposing deficiencies in current scoring systems. Here, we classify and describe deficiencies with current systems used for blast injury. Although current scoring systems highlight survival trends for populations, there are several major limitations. The reliable prediction of mortality on an individual basis is inaccurate. Other limitations include the saturation effect (where scoring systems are unable to discriminate between high injury score individuals), the effect of the overall injury burden, lack of precision in discriminating between mechanisms of injury, and a lack of data underpinning scoring system coefficients. Other factors influence outcomes, including the level of healthcare and the delay between injury and presentation. We recommend that a new score incorporates the severity of injuries with the mechanism of blast injury. This may include refined or additional codes, severity scores, or both, being added to the Abbreviated Injury Scale for high-frequency, blast-specific injuries; weighting for body regions associated with a higher risk for death; and blast-specific trauma coefficients. Finally, the saturation effect (maximum value) should be removed, which would enable the classification of more severe constellations of injury. An early accurate assessment of blast injury may improve management of mass casualty incidents.
Topics: Blast Injuries; Delivery of Health Care; Humans; Injury Severity Score; Mass Casualty Incidents; Prognosis; Time Factors; Triage
PubMed: 34774294
DOI: 10.1016/j.bja.2021.10.007 -
Journal of the Royal Army Medical Corps Feb 2019The majority of patients injured in the recent conflicts in Iraq and Afghanistan were as a result of explosion, and terrorist incidents have brought blast injuries to... (Review)
Review
The majority of patients injured in the recent conflicts in Iraq and Afghanistan were as a result of explosion, and terrorist incidents have brought blast injuries to the front door of many civilian hospitals that had not previously encountered such devastation. This article reviews the physics and pathophysiology of blast injury with particular relevance to the presentation and management of primary blast injury, which is the mechanism least familiar to most clinicians and which may cause devastating injury without externals signs.
Topics: Animals; Biomedical Research; Blast Injuries; Humans; Military Medicine; Military Personnel
PubMed: 30317218
DOI: 10.1136/jramc-2018-001058 -
British Journal of Anaesthesia Mar 2017Bomb or explosion-blast injuries are likely to be increasingly encountered as terrorist activity increases and pre-hospital medical care improves. We therefore reviewed... (Review)
Review
Bomb or explosion-blast injuries are likely to be increasingly encountered as terrorist activity increases and pre-hospital medical care improves. We therefore reviewed the epidemiology, pathophysiology and treatment of primary blast lung injury. In addition to contemporary military publications and expert recommendation, an EMBASE and MEDLINE search of English speaking journals was undertaken using the medical subject headings (MeSHs) ‘blast injury’ and ‘lung injury’. Review articles, retrospective case series, and controlled animal modelling studies published since 2000 were evaluated. 6-11% of military casualties in recent conflicts have suffered primary blast lung injury but the incidence increases to more than 90% in terrorist attacks occurring in enclosed spaces such as trains. The majority of victims require mechanical ventilation and intensive care management. Specific therapies do not exist and treatment is supportive utilizing current best practice. Understanding the consequences and supportive therapies available to treat primary blast lung injury are important for anaesthetists.
Topics: Blast Injuries; Humans; Lung; Lung Injury
PubMed: 28203741
DOI: 10.1093/bja/aew385 -
Journal of the Royal Naval Medical... 2011Blast lung injury is an increasing problem for UK forces in Afghanistan, but is not a new phenomenon, with evidence that it has been increasing in incidence over the... (Review)
Review
Blast lung injury is an increasing problem for UK forces in Afghanistan, but is not a new phenomenon, with evidence that it has been increasing in incidence over the last century. Management is conservative, but there are newer therapies that may play a role in the future management of this condition.
Topics: Afghan Campaign 2001-; Blast Injuries; Humans; Incidence; Lung Injury
PubMed: 22372014
DOI: No ID Found -
Critical Care Nursing Clinics of North... Jun 2015Blast trauma can kill or injure by multiple different mechanisms, not all of which may be obvious on initial presentation. Patients injured by blast effects should be... (Review)
Review
Blast trauma can kill or injure by multiple different mechanisms, not all of which may be obvious on initial presentation. Patients injured by blast effects should be treated as having multisystem trauma and managed according to Advanced Trauma Life Support guidelines. For the most severely injured patients, damage control resuscitation should be practiced until definitive hemorrhage control has been achieved. Patients with blast injuries may present in mass-casualty episodes that can overwhelm local resources. This article reviews some specific injuries, as well as the importance of mild traumatic brain injury. The importance of rehabilitation is discussed.
Topics: Blast Injuries; Brain Injuries, Traumatic; Humans; Military Personnel; Multiple Trauma; Resuscitation; Terrorism
PubMed: 25981729
DOI: 10.1016/j.cnc.2015.02.007 -
Behavioural Brain Research Mar 2018Between April 2007 and December 2015, the Veterans Health Administration (VHA) screened one million combat veterans for traumatic brain injury (TBI), among 2.6 million... (Review)
Review
Between April 2007 and December 2015, the Veterans Health Administration (VHA) screened one million combat veterans for traumatic brain injury (TBI), among 2.6 million deployed during operations Enduring Freedom, Iraqi Freedom and New Dawn (OEF/OIF/OND). Since 2007, among those reporting, screened and referred for definitive evaluation, approximately 8.4% of these Veterans received a diagnosis of TBI, the majority characterized as mTBI/Concussion (mTBI) and, in great proportion, related to blast exposures. Mild Traumatic brain injury called "a signature injury" is also known as 'the invisible injury' of these conflicts. Identifying and assessing neuropathological, cellular and resulting cognitive, emotional, behavioral and neurological consequences of mTBI comprise vast clinical and research challenges. We provide a brief overview of current history, injury mechanisms related to blast exposure, coordinated research support, and the need to understand specific cellular and neurological changes occurring with blast injury, particularly mTBI.
Topics: Animals; Blast Injuries; Brain Injuries, Traumatic; Humans; War-Related Injuries
PubMed: 27555540
DOI: 10.1016/j.bbr.2016.08.036 -
Anasthesiologie, Intensivmedizin,... Jun 2010The blast injury is characterized by 3 different patterns of injury: blast wave, splintered fragments and displacement of victim's body. Severe external and internal... (Review)
Review
The blast injury is characterized by 3 different patterns of injury: blast wave, splintered fragments and displacement of victim's body. Severe external and internal hemorrhage, tension pneumothorax and the lethal trios (hypothermia, acidosis, coagulopathy) require a rapid prehospital and inhospital trauma care according to a standardized protocol. The concepts of damage control resuscitation and damage control surgery have proven to be effective and should be integrated into the treatment.
Topics: Blast Injuries; Blood Coagulation Disorders; Clinical Protocols; Emergency Medical Services; Humans; Multiple Trauma; Resuscitation
PubMed: 20539962
DOI: 10.1055/s-0030-1255342 -
World Neurosurgery Feb 2021Mass casualty incidents (MCIs) due to bombing-related terrorism remain an omnipresent threat to our global society. The aim of this study was to elucidate differences in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Mass casualty incidents (MCIs) due to bombing-related terrorism remain an omnipresent threat to our global society. The aim of this study was to elucidate differences in blast injury patterns between military and civilian victims affected by terrorist bombings.
METHODS
An analysis of the Global Terrorism Database (GTD) and a PubMed literature search of casualty reports of bombing attacks from 2010-2020 was performed (main key words: blast injuries/therapy, terrorism, military personnel) with key epidemiological and injury pattern data extracted and statistically analyzed.
RESULTS
Demographic analysis of casualties revealed that military casualties tend to be younger and predominantly male (P < 0.05) compared with civilians. Military casualties also reported higher amounts of head/neck injury (P < 0.01) compared with civilians. The proportion of instantaneous fatalities along with injuries affecting the thoracoabdominal and extremity regions remained approximately equal across both groups.
CONCLUSIONS
Though the increased number of head/neck injuries was unexpected, we also found that the number of nonlethal head injuries also increased, predicating that more military blast neurotrauma patients survived their injuries. These data can be used to increase blast MCI preparation and education throughout the international neurosurgical community.
Topics: Blast Injuries; Brain Injuries, Traumatic; Humans; Mass Casualty Incidents; Military Personnel
PubMed: 33246181
DOI: 10.1016/j.wneu.2020.11.093 -
Medical Engineering & Physics Jul 2021Blast injuries remain a serious threat to defence and civilian populations around the world. 'Primary' blast injuries (PBIs) are caused by direct blast wave interaction... (Review)
Review
Blast injuries remain a serious threat to defence and civilian populations around the world. 'Primary' blast injuries (PBIs) are caused by direct blast wave interaction with the human body, particularly affecting air-containing organs. Work to define blast loading conditions for injury research has received relatively little attention, though with a continued experimental focus on PBIs and idealised explosion assumptions, meaningful test outcomes and subsequent clinical applications, rely on appropriate simulated conditions. This paper critically evaluates and combines existing PBI criteria (grouped into those affecting the auditory system, pulmonary injuries and brain trauma) as a function of idealised blast wave parameters. For clinical blast injury researchers, analysis of the multi-injury criteria indicates zones of appropriate loading conditions for human-scale test items and demonstrates the importance of simulating blast conditions that are both realistic and relevant to the injury type. For certain explosive scenarios, spatial interpretation of the 'zones of relevance' could support emergency response and hazard preparedness by informing triage, patient management and resource allocation, thus leading to improved health outcomes. This work will prove useful to clinical blast injury researchers, blast protection engineers and clinical practitioners involved in the triage, diagnosis, and treatment of PBIs.
Topics: Blast Injuries; Consensus; Explosions; Explosive Agents; Humans
PubMed: 34154779
DOI: 10.1016/j.medengphy.2021.05.014