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At least 19 recordsLinked to original sources
PubMed1993

[Effect of burn injury, blast injury and combined burn-blast injury on immune reactions of thymocytes and splenocytes in rats].

Rats were inflicted with burn (15% TBSA full-thickness) by flash thermal radiation, blast injury in shock tube (over pressure 429.3 +/- 11.5 kPa) and both of them, respectively. The dynamic changes of several cellular immune reactions of thymocytes and splenocytes were observed. One hour after injuries, the immune reactions were significantly enhanced in combined injury group as well as in blast injury group, but somewhat depressed in burn group. 12 hours after injuries, the immune reactions in all three groups were obviously depressed. It was found that the degree of depression showed an order as follows: Combined injury > Blast injury > Burn. The combined effects were more serious than that of the sum of two single injuries, and the combined injury recovered more slowly than the other two. Therefore, an aggravated effect was observed in combined injury in this experiment.

Animals↗
PubMedDate not supplied

[Primary blast injuries].

Blast injuries are defined as injuries occurring under effects of blast wave caused by explosion. They can be primary (exclusively due to blast wave effects), secondary (impact of fragments from the environmental material), and tertiary (whole body displacement and impact into solid objects or ground). Today they are result of war operations, terrorist actions and accidents in industry and households. One of the basic characteristics of primary blast injury are severe and even fatal damages, primarily of air-containing organs (respiratory and digestive tracts, auditory system) with simultaneous lack of visible external signs of injuries. Except for magnitude and duration (over-pressure) of the blast wave, the severity of injury depends also on other factors. When the blast wave reaches the lethal level, most of the lethal cases occur during the first 2 hours after injury, and those who survive have good chance for recovery. Some measures and procedures can lessen the harmful effects of blast wave, however, effective protection is not available.

Blast Injuries↗
PubMed1995

Maxillofacial blast injuries.

Blast injuries cause specific lesions and occur more often than previously, because of the wide use of explosives. This is especially the case in wartime. More and more people lose their lives every day due to blast injuries. The mechanism of the injury and pathophysiology of this trauma are discussed. The clinical effects as well as management are presented. The most dramatic effects observed are fractures to the middle third of the face, reported here for the first time, with their management. New fracture lines are typically seen in fractures of the mandible due to the blast wave effects. This presentation should help in the prevention and management to save the lives of patients in future.

Blast Injuries↗
PubMed1985

Auditory brainstem evoked potentials in blast injury.

Blast injury typically consists of a mixed conductive and sensorineural hearing loss. The sensorineural component includes temporary as well as permanent threshold elevations. Auditory brainstem evoked potentials (ABEP) are sensitive to functional changes in various levels along the auditory pathway. ABEP were recorded from 37 survivors of blasts and latency measures were correlated with clinical findings. Prolongation of peak latencies was correlated with the conductive component of blast-induced hearing loss, as well as with the TTS component of the sensorineural impairment. No central effects of blast on the auditory system were detected. In addition to their objectivity, ABEP hold the promise of differentiating between the permanent and temporary effects of blast on hearing.

Adult↗
PubMedDate not supplied

Blast injuries.

Blast injuries cause specific lesions with which the radiologist should be familiar. The mechanism of injury and the pathophysiology of this form of trauma are discussed. The clinical effects as well as the radiologic observations in various organs are presented. Most dramatic effects are observed in the thorax.

Barotrauma↗
PubMed1997

Management of primary blast injury.

Blast waves are produced following the detonation of munitions, the firing of large caliber guns, or from any type of explosion. These blast waves can be powerful enough to injure the individuals exposed to them. This type of injury is called primary blast injury (PBI) and the organs most vulnerable to PBI are the gas-filled organs, namely the ear, the lungs and the gastrointestinal tract. The approach to the casualty with PBI is the same as it would be for any trauma victim, i.e. the initiation of life support measures. Attention should be directed to the common life-threatening manifestation of thoracic and abdominal PBI. Pulmonary manifestations would include hemorrhage, barotrauma and arterial air embolism, while abdominal manifestations would include hemorrhage and hollow organ rupture. Therapy is directed at the specific manifestations as well as avoiding additional iatrogenic injury.

Air Pressure↗
PubMed2006

[Blast injury to the spleen and pancreas after a non-penetrating gunshot wound--result after 12 years].

The spleen is the most frequently injured organ in adults who sustain blunt abdominal trauma. The aim is to report on a patient with non-penetrating gunshot traumatic injury to the spleen and pancreas, and to evaluate the result after 12 years A soldier with gunshot wound of the left lateral abdominal wall was admitted to the Military Hospital in Mostar in the year 1993. The patient was hemodynamically unstable and underwent emergency surgery. On wound exploration, there was no abdominal penetration. Because of hemodynamic instability, we decided to perform emergency laparotomy and abdominal exploration. The spleen and distal pancreas were shattered. Splenectomy and hemostasis were performed. The peritoneum was closed and the abdominal wall wound healed secondarily. The patient was in good condition postoperatively. Now, after 12 years, the patient is free from any sequel of the war injury. Blast injury to the spleen can result from non-penetrating abdominal gunshot wounds despite the absence of injury to the peritoneum. In war conditions, the diagnosis and indications are usually based on clinical findings only because special investigations, including ultrasound and CT are not readily available. The management of splenic injury has been rapidly modified over the last decade, with ever more emphasis on splenic salvage and nonoperative management, however, these procedures cannot be performed in war conditions. War injuries to the spleen are life threatening and emergency open splenectomy is the only solution.

Adult↗
PubMed2001

Lightning injury as a blast injury of skull, brain, and visceral lesions: clinical and experimental evidences.

The present study attempts to better understand the mechanism of injuries associated with direct lightning strikes. We reviewed the records of 256 individuals struck by lightning between 1965 and 1999, including 56 people who were killed. Basal skull fracture, intracranial haemorrhage, pulmonary haemorrhage, or solid organ rupture was suspected in three men who died. Generally these lesions have been attributed to current flow or falling after being struck. However, examination of surface injuries sustained suggested that the true cause was concussion secondary to blast injury resulting from vaporization of water on the body surface by a surface flashover spark. To investigate this hypothesis, an experimental model of a lightning strike was created in the rat. Saline-soaked blotting paper was used to simulate wet clothing or skin, and an artificial lightning impulse was applied. The resultant lesions were consistent with our hypothesis that the blast was reinforced by the concussive effect of water vaporization. The concordance between the clinical and experimental evidence argues strongly for blast injury as an important source of morbidity and mortality in lightning strikes.

Adult↗
PubMedDate not supplied

[Blast injuries of the intestines in abdominal injuries].

Intestinal blast injuries inflicted by explosive devices were found in 410 wounded hospitalized at the Military Medical Academy. Primary blast perforations were found in 7 (1.7%) cases, and they were certain only in cases of the direct blast. Examination was directed toward the primary non-penetrating blast injuries of intestines not only because of their number 43 (11%), but also because they, if untreated, progressed into secondary perforations. Operative treatment of primary and secondary perforations was performed in accordance with the existing surgical war doctrine. Treatment of the intestinal wall hematoma as primary non-perforating blast injury included surgical procedure and medication. Secondary perforations 11 (3%) developed in untreated primary non-perforating blast injuries of intestines. They were treated operatively except in two cases of enterocutaneous fistulas where conservative treatment was applied.

Abdominal Injuries↗
PubMed2006

Treatment of blast injuries of the extremity.

Blast trauma is a complex event. Pathophysiologically, blast injuries are identified as primary (caused solely by the direct effect of blast overpressure on the tissue), secondary (caused by flying objects or fragments), tertiary (caused by bodily displacement), or quaternary (indirectly caused by the explosion). The range of primary blast injuries includes fractures, amputations, crush injury, burns, cuts, lacerations, acute occlusion of an artery, air embolism-induced injury, compartment syndrome, and others. Secondary injuries are the most common extremity blast injuries. Like primary injuries, they may necessitate limb amputation, be life-threatening, and produce severe contamination. Tertiary blast injuries of the extremity may result in traumatic amputations, fractures, and severe soft-tissue injuries. Quaternary injuries most often are burns. Following treatment and stabilization of immediate life-threatening conditions, all patients are given antibiotic and tetanus prophylaxis. Débridement and wound excision are started as early as possible, with repeat débridement performed as necessary; fasciotomies also are performed to prevent compartment syndrome. Well-vascularized muscular free flaps provide soft-tissue coverage for blast-injured extremities. The closed-open technique of flap closure allows reexamination of the wound, further irrigation, débridement, and later bone and soft-tissue reconstruction.

Blast Injuries↗
PubMedDate not supplied

Utility of mechanism-of-injury-based assessment and treatment: Blast Injury Program case illustration.

While medicine typically proceeds in a sequential fashion based on primary symptoms, sometimes relying on a parallel, mechanism-of-injury-based approach is advantageous, particularly when the mechanism of injury is associated with a variety of known sequelae. A mechanism-of-injury-based approach relies on knowledge of the typical sequelae associated with that mechanism of injury to guide assessment and treatment. Thus, it represents an active, rather than passive, case-finding approach. This article describes an example of a mechanism-of-injury-based program, namely, a Blast Injury Program at the James A. Haley Veterans Hospital in Tampa, Florida. Case examples illustrate the utility of this approach with regard to more comprehensive assessment and treatment, as well as the possibility for secondary prevention.

Adult↗
PubMedDate not supplied

[Therapeutic approach in blast injuries of the ear].

UNLABELLED: Otic blast injury is caused by arrhythmic air blast wave. The perforation of the tympanic membrane is the commonet finding associated with lacerations of mucosa in the middle ear. Makki [6] published 34 cases of myringoplasty after war blast injuries. However, healing of such perforations is common; Kerr [7] noted a healing rate of 83% after the blast injury. The aim of the study was to evaluate different therapic procedures of otic blast injuries. There were 74 patients with bilateral otic blast injuries, who underwent otomycroscopic examination. The following parameters were noted: Integrity of tympanic membrane and size of perforation, presence of haemorrhagic exudate in the middle ear and median value of conductive deafness (Table 2). Main symptoms, presented in Table 1 were: pain, deafness and otohaematorrhoea. The first group of 19 patients received antibiotics by parenteral way during 7 days according to the bacterial finding in ear exudate. Healing rate was dependent on the size of tympanic membrane perforation, and rated from 71% in perforation of one third of tympanic membrane to 25% in total perforation of tympanic membrane. Data are presented in Table 3. The second group of 24 patients received the same therapy as the first treatment, plus otomycroscopic removal of haemorrhagic exudate, lacerated middle ear mucosa, and repair of tympanic membrane lacerations. Healing rate was significantly better than the one obtained in the first group (Table 4). Persistent tympanic perforation, as indicator of failed therapy, was present in 5 (35%) of all examined ears with two thirds of tympanic membrane perforation in the first group, while in the second group the rate was 3 (12%). The third group received the same therapy as the second treatment, including administration of amicacyn into the external auditory canal. The results were statistically compared by chi 2 test, and we found that the second therapy protocol was significantly better. There was no significant difference between the second and the third therapy protocols. We found blast ruptures of tympanic membrane and auditory ossicles chain discontinuity in 88% of examined ears. In our material the high incidence of total tympanic membrane ruptures and subtotal ruptures (48%) is quite different in comparison to other authors [5-7]. We consider it as the effect of high power blast wave. Loss of conductive hearing was present in 91% of blast injured patients, while 7.4% of patients had mixed, predominantly senzoneural deafness. Consequently, in addition to mechanic blast injuries acoustic trauma could profoundly damage the inner ear. Spontaneous healing of tympanic membrane occurred in 71% of injured persons and this was a better result than the results obtained by other authors [3, 4, 6]. The spontaneous healing of tympanic membrane failed if infection of the middle ear occurred or blast caused the total tympanic membrane perforation. In the second and third therapy protocols significantly higher healing of tympanic membrane ruptures was evident; it rated from 88% to 91%. Better results could be explained by the effect of optimal healing conditions, based on removal of exudate from the middle ear and necrotic parts of tympanic membrane, completed by fitting of lacerated parts of tympanic membrane and antibiotic prophylaxis. Healing of tympanic membrane without scars and adhesions was more frequent than in patients treated only with antibiotics. Incidence of undesired outcome of persistent perforation of tympanic membrane was reduced. To prevent posttraumatic complications in the middle ear, we recommend early cleaning of margins, reposition of lacerated fragments of tympanic membrane, and removal of haemorrhagic exudate. Myringoplasty should be performed if spontaneous healing of tympanic membrane did not occur after 6 months. CONCLUSION: Otic blast injury was frequently found in war induced trauma. (ABSTRACT TRUNCATED)

Blast Injuries↗
PubMed1998

Global primary blast injury: a rat model.

Blast wave injury from bombs cause a unique but poorly understood spectrum of injuries. Previous blast wave models involved high energy explosives detonated in an open field without the sophisticated monitoring of laboratory equipment. We characterized a rodent model that produces a global blast injury in a safe laboratory environment. Male rats, prospectively randomized to four groups of ten, were anesthetized and subjected to a blast at 2.0 cm, 2.5 cm, or 3.5 cm from the blast nozzle. The control group received no blast. Intensity of the blast (80-120 psi peak pressure, 1-2 msec duration) was controlled by varying the distance of the blast wave generator to the rat. The rats were monitored for three hours following the blast and then euthanized. Bradycardia was an immediate but transient response to blast injury. Mean arterial pressure was bimodal with severe hypotension occurring immediately after the blast and, again, two to three hours later. The characteristic injuries from a blast wave, such as pulmonary hemorrhage with increased lung weight, intestinal serosal hemorrhage, and hemoperitoneum, were found in the rats subjected to the blast pressure wave. In conclusion, our rodent model accurately reproduces the clinical spectrum of injuries seen in blast victims and will provide a powerful tool for studying the pathophysiology and potential treatments of bomb blast victims.

Analysis of Variance↗
PubMed2002

A simple conceptual model of primary pulmonary blast injury.

Primary pulmonary blast injury arises from direct exposure to blast overpressure, and may lead to severe lung injury and systemic air embolism. The phenomena of spallation and implosion can be explained by a simple conceptual model without invoking complex physical principles.

Animals↗
PubMed2001

Reflex nature of the cardiorespiratory response to primary thoracic blast injury in the anaesthetised rat.

Blast injuries represent a problem for civilian and military populations. Primary thoracic blast injury causes a triad of bradycardia, hypotension and apnoea. The objective of this study was to investigate the reflex nature of this response and its modulation by vagotomy or administration of atropine. The study was conducted on terminally anaesthetised (alphadolone/alphaxalone, 18-24 mg x kg x h(-1), I.V.) male Wistar rats randomly allocated to the groups indicated below. Blast injuries were produced with compressed air while sham blast involved the sound of a blast only. Primary blast injury to the thorax resulted in a bradycardia (measured as an increase in the interval between beats, or heart period (HP) to 489 +/- 37 ms from 133 +/- 3 ms with a latency of onset of 4.3 +/- 0.3 s, mean +/- S.E.M.), hypotension (fall in mean arterial blood pressure (MBP) from 128.1 +/- 3.7 mmHg to 34.8 +/- 4.1 mmHg, latency of onset 2.0 +/- 0.1 s) and apnoea lasting 28.3 +/- 2.3 s. Sham blast had no effect. The bradycardia and apnoea following thoracic blast were abolished by cervical vagotomy while the hypotension was attenuated. Atropine (0.3 mg x kg(-1), I.V.) caused a significant reduction in the bradycardia (HP increasing from 124 +/- 3 ms to 142 +/- 4 ms) but did not modulate either the hypotension or apnoea. It is concluded that a reflex involving the vagus nerve mediates the bradycardia, apnoea and a component of the hypotension associated with thoracic blast. The pattern of this response is similar to effects that follow stimulation of the pulmonary afferent C-fibres.

Anesthesia↗
PubMed1989

Treatment of blast injury to the ear.

Blast injury to the ear has long been acknowledged as potentially incapacitating. This paper discusses the scope of these injuries in terms of the anatomic and physiologic consequences. Management of both acute and chronic injuries is discussed, with specific regard to the deficits in a patient's functional ability once blast injury has occurred.

Blast Injuries↗
PubMed2006

Predictors of mortality in close proximity blast injuries during Operation Iraqi Freedom.

BACKGROUND: Blast injury is an increasingly common problem faced by military surgeons in the field. Because of urban terrorism worldwide, blast injury is becoming more common in the civilian sector as well. Blast injuries are often devastating and can overwhelm medical resources. We sought to determine whether simple factors easily obtained from the clinical history and primary survey could be used to triage patients more effectively. STUDY DESIGN: A retrospective review of 18 consecutive close-proximity blast injury patients presenting to a forward deployed surgical unit in Iraq was performed. Patients' injuries and outcomes were recorded. We compared the presence of sustained hypotension, penetrating head injury, multiple (three or more) long-bone fractures, and associated fatalities (whether another patient involved in the same explosion died) between nonsurvivors and survivors using Fisher's exact test. RESULTS: All patients who presented alive but exhibited sustained hypotension (n = 5) died, versus 0% who did not exhibit sustained hypotension (n = 9, p < 0.01). There was no marked increase in mortality with presence of multiple long-bone fractures, penetrating head injury, or associated fatalities individually. Having two or more of these factors was associated with a mortality of 86% (6 of 7) versus 20% (2 of 10, p = 0.015) in those who had less than two factors. CONCLUSIONS: Blast injury can overwhelm military and civilian trauma systems alike. Sustained hypotension and presence of two or more easily determined factors, including three or more long-bone fractures, penetrating head injury, and associated fatalities, are associated with increased mortality and can potentially help triage patients and allocate scarce resources more efficiently.

Blast Injuries↗