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Blast syndrome – pathophysiology, diagnosis and treatment of blast injuries

Czech version

Authors: K. Havlová;  R. Doležel;  L. Hána;  Radek Pohnán
Authors‘ workplace: 1. chirurgická klinika 2. lékařské fakulty Univerzity Karlovy a Ústřední vojenská nemocnice Praha, Česká republika
Published in: Rozhl. Chir., 2023, roč. 102, č. 6, s. 236-243.
Category: Review
doi: https://doi.org/10.33699/PIS.2023.102.6.236–243

Overview

The incidence of explosions in large agglomerations is high even during peacetime and continues rising. Blast syndrome injuries are complex, with shock wave causing severe injuries of multiple organ systems. In situations with large numbers of injured persons, effective triage allows an early diagnosis and treatment of the highest number of victims. Treatment is challenging, and potentially conflicting therapeutic goals may alternate. This review provides an overview of the pathophysiology of blast injuries, current diagnostic algorithms and therapeutic procedures.

Keywords:

treatment – blast syndrome – explosion – multiple injuries

Sources
  1. RAND®-MIPT terrorism incident database (2023). RAND Corporation 1994–2023. Available at: www.rand.org.
  2. START (National Consortium for the Study of Terrorism and Responses to Terrorism). (2022). Global Terrorism Database 1970−2020. Available at: www.start. umd.edu/gtd.
  3. Terrorism situation and trend report (TESAT). Home office, statistics on terrorism arrests and outcomes in Great Britain. Europol EU 2021.
  4. Phillips YY. Primary blast injuries. Ann Emerg Med. 1986 Dec;15(12):1446−1450. doi:10.1016/s0196-0644(86)80940-4.
  5. Wolf SJ, Bebarta VS, Bonnett CJ, et al. Blast injuries. The Lancet 2009 Aug 1;374(9687):405−415. doi:10.1016/ S0140-6736(09)60257-9.
  6. Mathews RJ. The 1980 convention on certain conventional weapons: A useful framework despite earlier disappointments. International Review of the Red Cross 2001;83(844):991−1012.
  7. Kluger Y, Nimrod A, Biderman P, et al. The quinary pattern of blast injury. American Journal of Disaster Medicine 2007 Jan– Feb;2(1):21−25.
  8. Hazell GA, Pearce AP, Hepper AE, et al. Injury scoring systems for blast injuries: a narrative review. Br J Anaesth. 2022 Feb;128(2):e127−e134. doi:10.1016/j. bja.2021.10.007.
  9. Guy RJ, Kirkman E, Watkins PE, et al. Physiologic responses to primary blast. Journal of Trauma and Acute Care Surgery 1998 Dec;45(6):983−987. doi:10.1097/00005373-19981200000001.
  10. Sharpnack DD, Johnson AJ. Primary blast injury. Conventional warfare: ballistic, blast, and burn injurie. In: conventional warfare: ballistic, blast and burn injuries. Brief history. Borden Institute 1991:221−240.
  11. Mellor SG. The relationship of blast loading to death and injury from explosion World J Surg. 1992 SepOct;16(5):893−898.       doi:10.1007/ BF02066988.
  12. Avidan V, Hersch M, Armon Y, et al. Blast lung injury: clinical manifestations, treatment, and outcome. Am J Surg. 2005 Dec;190(6):927−931. doi:10.1016/j.amjsurg.2005.08.022.
  13. Arnold JL, Tsai MC, Halpern P, et al.Mass-casualty, terrorist bombings: epidemiological outcomes, resource utilization, and time course of emergency needs (Part I), Prehosp Disaster Med. 2003 Jul–Sep;18(3):220−234. doi:10.1017/ s1049023x00001096.
  14. Hirshberg B, Oppenheim-Eden A, Pizov R, et al. Recovery from blast lung injury: one-year follow-up. Chest 1999 Dec;116(6):1683−168.             doi:10.1378/ chest.116.6.1683.
  15. Garner MJ, Brett SJ. Mechanisms of injury by explosive devices. Anesthesiol Clin. 2007 Mar;25(1):147−160. doi:10.1016/j.anclin.2006.11.002.
  16. Argyros GJ. Management of primary blast injury. Toxicology 1997 Jul 25;121(1):105−115.  doi:10.1016/s0300-483x(97)03659-7.
  17. Mayorga MA. The pathology of primary blast overpressure injury, Toxicology 1997 Jul 25;121(1):17−28. doi:10.1016/ s0300-483x(97)03652-4.
  18. Ho AM, Ling E. Systemic air embolism after lung trauma, Anesthesiology 1999 Feb;90(2):564−575. doi:10.1097/00000542-19990200000033.
  19. Pizov R, Oppenheim-Eden A, Matot I, et al. Blast lung injury from an explosion on a civilian bus, Chest 1999 Jan;115(1):165−172. doi:10.1378/chest. 115.1.165.
  20. Villar J, Kacmarek RM, Perez-Mendez L, et al. A high positive end-expiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute res-piratory distress syndrome: a randomized, controlled trial. Crit Care Med. 2006 May;34(5):1311−1318. doi:10.1097/01. CCM.0000215598.84885.01.
  21. Marti M, Parron M, Baudraxler F, et al. Blast injuries from Madrid terrorist bombing attacks on March 11, 2004, Emerg Radiol. 2006 Dec;13(3):113−122. doi:10.1007/s10140-006-0534-4. Epub 2006 Nov 14.
  22. Paran H, Neufeld D, Shwartz I, et al. Perforation of the terminal ileum induced by blast injury: delayed diagnosis or delayed perforation? J Trauma 1996 Mar;40(3):472−475. doi: 10.1097/00005373-199603000-00029.
  23. Cripps NP, Cooper GJ. Risk of late perforation in intestinal contusions caused by ex-plosive blast. Br J Surg. 1997 Sep;84(9):1298−1303.
  24. Blackbourne LH. Combat damage control surgery. Crit Care Med. 2008 Jul;36(7 Suppl):S304−310. doi:10.1097/ CCM.0b013e31817e2854.
  25. Rippey JC, Royse AG. Ultrasound in trauma. Best Pract Res Clin Anaesthesiol. 2009 Sep;23(3):343−362. doi:10.1016/j. bpa.2009.02.011.
  26. Cave KM, Cornish EM, Chandler DW. Blast injury of the ear: clinical update from the global war on terror. Mil Med. 2007 Jul;172(7):726−730. doi:10.7205/milmed.172.7.726.
  27. Ritenour AE, Wickley A, Ritenour JS, et al. Tympanic membrane perforation and hearing loss from blast overpressure in operation Enduring Freedom and operation Iraqi Freedom wounded. J Trauma 2008 Feb;64(2 Suppl):S174−178; discussion S178. doi:10.1097/TA. 0b013e318160773e.
  28. Harrison CD, Bebarta VS, Grant GA. Tympanic membrane perforation after combat blast exposure in Iraq: a poor biomarker of primary blast injury. J Trauma 2009 Jul;67(1):210−211. doi:10.1097/ TA.0b013e3181a5f1db.
  29. Bhattacharjee Y. Neuroscience. Shell shock revisited: solving the puzzle of blast trauma, Science 2008 Jan 25;319(5862):406−408. doi:10.1126/science.319.5862.406.
  30. Finkel MF. The neurological consequences of explosives. J Neurol Sci. 2006 Nov 1;249(1):63−67. doi:10.1016/j. jns.2006.06.005.
  31. Taber KH, Warden DL, Hurley RA. Blast-related traumatic brain injury: what is known? J Neuropsychiatry Clin Neurosci. 2006 Spring;18(2):141−145. doi:10.1176/ jnp.2006.18.2.141.
  32. Xydakis MS, Bebarta VS, Harrison CD, et al. Tympanic-membrane perforation as a marker of concussive brain injury in Iraq. N Engl J Med. 2007 Aug 23;357(8):830−831. doi:10.1056/NEJMc076071.
  33. Okie S. Traumatic brain injury in the war zone. N Engl J Med. 2005 May 19;352(20):2043−2407. doi:10.1056/NEJMp058102.
  34. Owens BD, Kragh JF Jr, Wenke JC, et al. Combat wounds in operation Iraqi Freedom and operation Enduring Freedom. J Trauma. 2008 Feb;64(2):295−299. doi:10.1097/TA.0b013e318163b875.
  35. Tremblay LN, Feliciano DV, Rozycki GS. Secondary extremity compartment syndrome. J Trauma. 2002 Nov;53(5):833−837. doi:10.1097/00005373-20021100000005.
  36. Stansbury LG, Lalliss SJ, Branstetter JG, et al. Amputations in U.S. military personnel in the current conflicts in Afghanistan and Iraq. J Orthop Trauma. 2008 Jan;22(1):43−46. doi:10.1097/ BOT.0b013e31815b35aa.
  37. Frykberg ER, Tepas JJ 3rd. Terrorist bombings. Lessons learned from Belfast to Beirut. Ann Surg. 1988 Nov;208(5):569−576. doi:10.1097/00000658-19881100000005.
  38. Tse KM, Lee Robinson D, Franklyn M, et al. Effect of sitting posture on pelvic injury risk under vertical loading. J Mech Behav Biomed Mater. 2020 Aug;108:103780. doi:10.1016/j.jmbbm.2020.103780.
  39. Weaver C, Berkan G, Miller A, et al. Pelvic response of a total human body finite element model during simulated injurious under body blast impacts. ASCE-ASME Journal of Risk and Uncertainty in Engineering Systems, Part B: Mechanical Engineering. 2021:7(2).
  40. Kauvar DS, Wolf SE, Wade CE, et al. Burns sustained in combat explosions in Operations Iraqi and Enduring Freedom (OIF/OEF explosion burns). Burns 2006 Nov;32(7):853−857. doi:10.1016/j. burns.2006.03.008.
  41. Zajíček R, Doležel R, Kaloudová Y, et al. Early surgical management in patients with burns. [In Czech] Rozhl Chir. 2019 Spring;98(5):194−199.
  42. Karimi A, Razaghi R, Navidbakhsh M, et al. Computing the stresses and de-formations of the human eye components due to a high explosive detonation using fluid-structure interaction model. Injury 2016 May;47(5):1042−1050. doi:10.1016/j.injury.2016.01.030. Epub 2016 Feb 4.
  43. Orhon R, Eren SH, Karadayı S, et al. Comparison of trauma scores for predicting mortality and morbidity on trauma patients. Ulus Travma Acil Cerrahi Derg. 2014 Jul;20(4):258−264. doi:10.5505/ tjtes.2014.22725.
  44. Christian MD. Triage. Crit Care Clin. 2019 Oct;35(4):575−589. doi:10.1016/j.ccc.2019.06.009. Epub 2019 Jul 27.
  45. Lecky F, Woodford M, Edwards A, et al. Trauma scoring systems and databases. Br J Anaesth. 2014 Aug;113(2):286−294. doi:10.1093/bja/aeu242.
  46. The American College of Surgeons, advanced trauma life support® student course manual 10th edition, 2018.
  47. Balazs GC, Blais MB, Bluman EM, et al. Blurred front lines: triage and initial management of blast injuries. Curr Rev Musculoskelet Med. 2015 Sep;8(3):304−311. doi:10.1007/s12178-015-9288-5.
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