Blast lung

Centers for Disease Control and Prevention. (2005a). Blast lung injury What clinicians need to know. Retrieved June 17,2006, from http //www.bt.cdc.gov/masstrauma/pdf/ blastlunginjury.pdf... 

Significant primary blast injury only occurs in those who have been exposed to high blast loading and are consequently very close to the point of detonation (remember the pressure distance curve. Fig. 3.2). As a result, most such casualties will have died from secondary or tertiary injuries. However, reflection and summation in closed spaces may be associated with a significant incidence of primary injuries in survivors of atrocities in areas such as bars and buses. In one Israeli bus bomb incident, incidences of 76% for eardrum perforation, 38% for blast lung and 14% for abdominal blast injury were found. 

The heart is clearly at risk of direct penetrating injury. Such injuries have a poor prognosis. In blast lung, air may enter the circulation via traumatic alveolo-venous fistulae. Clinical consequences usually arise from impaction in the coronary or cerebral circulations (see p. 111-112). Such embolisation is widely considered to be one of the most likely causes of sudden otherwise unexplained death following blast exposure. Signs of coronary or local air emboli are given in Box 3.11. 

Clinical primary blast injury to the lungs ( blast lung ) appears to be rare in survivors of conventional explosions. There is considerable variation in the incidence of blast lung amongst survivors, depending on the site of the detonation (enclosed or open) and the presence or absence of fragments which themselves could result in fatal injury. 

The term blast lung is conventionally used to describe pulmonary contusion and associated respiratory failure... 

The diagnosis of blast lung is based on a high index of suspicion, clinical features (Table 3.3 Box 3.14) and radiological investigation (Box 3.15). 

Disseminated intravascular coagulation (DlC) and hypokalaemia (before intravenous fluid therapy) have both been associated with blast lung injury. Conventional therapy including fresh frozen plasma... 

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