Incidence of Primary Blast Injury in US Military Overseas Contingency Operations

Ritenour, Amber E.; Blackbourne, Lorne H.; Kelly, Joseph F.; McLaughlin, Daniel F.; Pearse, Lisa; Holcomb, John B.; Wade, Charles E.

doi:10.1097/sla.0b013e3181e01270

Cited by 99 publications

(51 citation statements)

References 30 publications

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“…Ramasamy et al [11] themselves state very explicitly 'We report a different pattern of injury caused by the EFP-IED compared with conventional explosive devices'. A very recent review of military casualties [12] concluded that 71 per cent of combat casualties admitted to medical treatment facilities during [2003][2004][2005][2006] were the result of explosions, and the proportion of these suffering blast lung injury was very small (3.6%). However, the definition of blast lung (a primary blast injury) used in this study could have significantly underestimated the true incidence since 'Patients found to have rib-fractures, scapula fractures, or open wounds to the chest were included in the study but were considered to have injuries caused by secondary or tertiary explosive mechanisms' [12].…”

Section: Classification Of Blast Injuriesmentioning

confidence: 99%

“…A very recent review of military casualties [12] concluded that 71 per cent of combat casualties admitted to medical treatment facilities during [2003][2004][2005][2006] were the result of explosions, and the proportion of these suffering blast lung injury was very small (3.6%). However, the definition of blast lung (a primary blast injury) used in this study could have significantly underestimated the true incidence since 'Patients found to have rib-fractures, scapula fractures, or open wounds to the chest were included in the study but were considered to have injuries caused by secondary or tertiary explosive mechanisms' [12]. While this is a very 'safe' definition of blast lung where it is essential to exclude all other possibilities, it will exclude blast lung injuries when it co-exists with other injury types, which is common with conventional munitions and terrorist bombs and hence may underestimate the occurrence of blast lung in current in military casualties.…”

Section: Classification Of Blast Injuriesmentioning

confidence: 99%

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Blast injury research models

Kirkman

Watts

Cooper

2011

Phil. Trans. R. Soc. B

103

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Blast injuries are an increasing problem in both military and civilian practice. Primary blast injury to the lungs (blast lung) is found in a clinically significant proportion of casualties from explosions even in an open environment, and in a high proportion of severely injured casualties following explosions in confined spaces. Blast casualties also commonly suffer secondary and tertiary blast injuries resulting in significant blood loss. The presence of hypoxaemia owing to blast lung complicates the process of fluid resuscitation. Consequently, prolonged hypotensive resuscitation was found to be incompatible with survival after combined blast lung and haemorrhage. This article describes studies addressing new forward resuscitation strategies involving a hybrid blood pressure profile (initially hypotensive followed later by normotensive resuscitation) and the use of supplemental oxygen to increase survival and reduce physiological deterioration during prolonged resuscitation. Surprisingly, hypertonic saline dextran was found to be inferior to normal saline after combined blast injury and haemorrhage. New strategies have therefore been developed to address the needs of blast-injured casualties and are likely to be particularly useful under circumstances of enforced delayed evacuation to surgical care.

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Section: Classification Of Blast Injuriesmentioning

confidence: 99%

Section: Classification Of Blast Injuriesmentioning

confidence: 99%

Blast injury research models

Kirkman

Watts

Cooper

2011

Phil. Trans. R. Soc. B

103

View full text Add to dashboard Cite

show abstract

“…The hemodynamic parameters, namely, the mean arterial pressure (MAP), cardiac index (CI), intrathoracic blood volume index (ITBI), systemic vascular resistance index (SVRI), cardiac function index (CFI), and extravascular lung water index (ELWI), were assessed with pulse-induced contour cardiac output (PiCCO, Pulsion, Germany) using the thermal dilution method prior to the burn injury experiment at 30 min, as well as at 2,4,8,12,18, and 24 h after injury [11][12][13].…”

Section: Hemodynamics Measurementsmentioning

confidence: 99%

“…With the development of high-technology weaponry, the morbidity of combined injuries sustained in local wars and terrorist attacks has increased rapidly [1,2]. The detonation of an explosive generates shock wave and heat, causing burn-blast combined injury and aggravating the wound by the interaction of blast and burns [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Development of an Animal Model for Burn-Blast Combined Injury and Cardiopulmonary System Changes in the Early Shock Stage

Chai

et al. 2014

Indian J Surg

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The purposes of this study were to establish an animal model for burn-blast combined injury research and elaborate cardiopulmonary system changes in the early shock stage. In this study, royal demolition explosive or RDX (hexagon, ring trimethylene nitramine) was used as an explosive source, and the injury conditions of the canine test subjects at various distances to the explosion (30, 50, and 70 cm) were observed by gross anatomy and pathology to determine a larger animal model of moderate blast injury. The canines were then subjected to a 35 % total body surface area (TBSA) full-thickness flame injury using napalm, which completed the development of a burn-blast combined injury model. Based on this model, the hemodynamic changes and arterial blood gas analysis after the burnblast combined injury were measured to identify the cardiopulmonary system characteristics. In this research, RDX explosion and flame injury were used to develop a severe burn-blast injury animal model that was stable, close to reality, and easily controllable. The hemodynamic and arterial blood gas changes in the canine subjects after burn-blast injury changed distinctly from the burn and blast injuries. Blood pressure and cardiac output fluctuated, and the preload was significantly reduced, whereas the afterload significantly increased. Meanwhile, the oxygen saturation (SO 2 ) decreased markedly with carbon dioxide partial pressure (PCO 2 ), and lactic acid (Lac) rose, and oxygen partial pressure (PO 2 ) reduced. These changes suggested that immediate clinical treatment is important during burn-blast injury both to stabilize cardiac function and supply blood volume and to reduce the vascular permeability, thereby preventing acute pneumonedema or other complications.

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“…Explosive or blast injuries are a current and very significant clinical issue in military medicine, with a significant number of casualties being injured by improvised explosive devices in the current conflicts in Iraq and Afghanistan [1][2][3]. Unfortunately, blast injuries also impact on civilian medicine, most dramatically when terrorist bombings cause mass casualties [4][5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Characterization of the response to primary blast injury

Kirkman

Watts

2011

Phil. Trans. R. Soc. B

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Lung injuries, predominantly arising from blast exposure, are a clinical problem in a significant minority of current military casualties. This special feature consists of a series of articles on lung injury. This first article examines the mechanism of the response to blast lung (primary blast injury to the lung). Subsequent articles examine the incidence of blast lung, clinical consequences and current concepts of treatment, computer (in silico) modelling of lung injury and finally chemical injuries to the lungs. Blast lung is caused by a shock wave generated by an explosion causing widespread damage in the lungs, leading to intrapulmonary haemorrhage. This, and the ensuing inflammatory response in the lung, leads to a compromise in pulmonary gas exchange and hypoxia that can worsen over several hours. There is also a characteristic cardio-respiratory effect mediated via an autonomic reflex causing apnoea (or rapid shallow breathing), bradycardia and hypotension (the latter possibly also due to the release of nitric oxide). An understanding of this response, and the way it modifies other reflexes, can help the development of new treatment strategies for this condition and for the way it influences the patient's response to concomitant injuries.

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Incidence of Primary Blast Injury in US Military Overseas Contingency Operations

Abstract: Injury severity and incidence of primary blast injury increased during the 4-year period, whereas return-to-duty rates decreased. Despite increasingly devastating injuries, the mortality rate due to explosion injuries remained low and unchanged.

Cited by 99 publications

References 30 publications

Blast injury research models

Blast injury research models

Development of an Animal Model for Burn-Blast Combined Injury and Cardiopulmonary System Changes in the Early Shock Stage

Characterization of the response to primary blast injury

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