Blast Lung Injury

Abstract

Current trends in global terrorism mandate that emergency medical services, emergency medicine andother acute care clinicians have a basic understanding of the physics of explosions, the types of injuries that can result from an explosion, andcurrent management for patients injured by explosions. High-order explosive detonations result in near instantaneous transformation of the explosive material into a highly pressurized gas, releasing energy at supersonic speeds. This results in the formation of a blast wave that travels out from the epicenter of the blast. Primary blast injuries are characterized by anatomical andphysiological changes from the force generated by the blast wave impacting the body's surface, andaffect primarily gas-containing structures (lungs, gastrointestinal tract, ears). “Blast lung” is a clinical diagnosis andis characterized as respiratory difficulty andhypoxia without obvious external injury to the chest. It may be complicated by pneumothoraces andair emboli andmay be associated with multiple other injuries. Patients may present with a variety of symptoms, including dyspnea, chest pain, cough, andhemoptysis. Physical examination may reveal tachypnea, hypoxia, cyanosis, anddecreased breath sounds. Chest radiography, computerized tomography, andarterial blood gases may assist with diagnosis andmanagement; however, they should not delay diagnosis andemergency interventions in the patient exposed to a blast. High flow oxygen, airway management, tube thoracostomy in the setting of pneumothoraces, mechanical ventilation (when required) with permissive hypercapnia, andjudicious fluid administration are essential components in the management of blast lung injury.