Management of Blast Related Injuries

Abstract

related injuries are common in military conflict and can also result from action by terrorist groups against civilian targets. The pattern of injury depends on the type of explosive, with high explosives capable of causing unique effects through the action of the blast wave. The environment is critically important in determining the effects of blast injury, with blast in enclosed spaces or underwater magnifying the effect of blast wave force transmission. Blasts can also cause ballistic injury by energising projectiles, blunt trauma from structural collapse, and thermal and toxic injuries. ``Blast Lung{''} is imprecisely defined but results from damage at the alveolar capillary interface with the predominant feature being pulmonary haemorrhage. Death is most commonly caused by severe cardiovascular impairment resulting from arterial gas embolism. The incidence of severe respiratory failure in survivors of blast injury is probably quite low. Management is essential supportive and similar to that applied to other forms of lung injury in critically injured patients. Attention should be paid to lung protective ventilation and a conservative fluid management strategy. Specific novel therapies such as pro or anti-coagulants and steroids remain unproven.