Blast-related lung injuries

Abstract

Blast-related lung injuries are occurring with increased frequency in a variety of circumstances, necessitating that both civilian and military providers across the healthcare spectrum understand how to promptly diagnose and manage these injury patterns. Primary, secondary, and tertiary blast injury mechanisms are most commonly encountered and can result in primary blast lung injury, air embolism, pulmonary contusion, rib fractures, and penetrating lung injuries. Primary blast lung injury occurs when a blast wave injures the lung parenchyma and vasculature and presents as acute dyspnea, cough, and hypoxemia with airspace disease on chest imaging. The treatment of primary blast lung injury, as well as other blast-related lung injuries, involves maintaining oxygenation and using a lung-protective strategy with low tidal volumes and minimal PEEP for patients requiring mechanical ventilation. Pain management, preferably in the form of regional anesthesia, is also crucial in improving outcomes in patients with blast-related lung injury.Keywords Primary blast lung injury . Explosion . Blunt thoracic trauma . Penetrating lung injury A 25-year-old male with no past medical history is transported to a hospital by ambulance after suffering multiple traumatic thoracic injuries when a bomb was detonated within 30 m of him at a sporting event. He has several soft tissue injuries over the torso and extremities. Pressure dressings were applied by first responders with hemostasis achieved. His vital signs include a temperature of 37.8°C, heart rate of 114/min, blood pressure of 92/50 mmHg, respiratory rate of 28/min, and oxygen saturation of 91 % on 15 LPM of oxygen via nonrebreather mask. His thoracic injuries include several leftsided non-displaced rib fractures with associated pulmonary contusion, a left-sided pneumothorax, and primary blast lung injury (PBLI). A chest CT (Fig. 1) in the Emergency Department demonstrates some of these findings. How should his case be managed?

Frequency-dependent ventilation heterogeneity in the acutely injured lung

“…Internal reflection of blast waves at the boundaries between the lung and surrounding tissue may result in constructive interference of pressure waves within the lungs, known as "stress concentration" [42]. Such injurious mechanisms might explain the radiographic presentation of PBLI, often characterized as a "butterfly" pattern of bilateral perihilar infiltrates, depending on the orientation of the victim with respect to the pressure wave origin [65]- [67].…”