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Blast Lung

Blast Injury of Lung

Blast lung is caused by explosive detonations and is characterized by serious lung damage. Other organs affected by blast injuries include the gastrointestinal tract and the ears.


Presentation

Blast lung is one of the consequences suffered from increased air pressure directed at tissue following an explosion. While the lungs are most prone to primary blast injury [1], other gas-containing sites such as the bowels and ears are also susceptible [2] [3]. Further secondary and tertiary blast mechanisms include penetrating and blunt force traumas well as burns [1] [4].

The clinical presentation of blast lung features dyspnea, cough, and hypoxia. Additionally, patients rapidly develop respiratory impairment, which evolves into acute respiratory distress syndrome (ARDS) [5] [6]. With regards to the prognosis, one study reported that the majority of surviving victims in a bus bombing recovered pulmonary function at the one-year follow-up [7].

Complications

Primary blast injury results in pulmonary barotrauma and encompasses serious sequelae such as pulmonary contusion, pulmonary hemorrhage, pulmonary edema, and venous air embolism. Moreover, blunt force injuries are frequently associated with bone marrow embolism and pulmonary fat embolism [8], which is a risk factor for ARDS and death [9]. The leading causes of death are hemothorax, pneumothorax, and extrathoracic trauma [10].

Physical exam

Primary blast injury produces key cardiovascular changes such as bradycardia as well as a drop in stroke volume and cardiac index. Additionally, auscultation of the lungs reveals wheezing, which is suggestive of pulmonary contusion, pulmonary edema, ARDS, and/or inhalation of irritants.

Hypoxemia
  • After clinical and laboratory data were collected, a BLI severity score was defined based on hypoxemia (PaO2/FIO2 ratio), chest radiographic abnormalities, and barotrauma.[ncbi.nlm.nih.gov]
  • Clinical interventions All patients with suspected or confirmed BLI should receive supplemental high flow oxygen sufficient to prevent hypoxemia (delivery may include non-rebreather masks, continuous positive airway pressure, or endotracheal intubation[slideplayer.com]
  • 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.[link.springer.com]
Camping
  • METHOD: Patients from the intensive care unit (ICU) of the Role 3 Medical Treatment Facility at Camp Bastion, Helmand Province, Afghanistan were studied over a five month period commencing in 2012.[ncbi.nlm.nih.gov]
Eruptions
  • المحتويات Flood 489 HeatWave 496 Volcanic Eruption 502 Landslides 509 NuclearRadiation Events 517 Ionizing Radiation Incident 524 Radiation AccidentIsolated Exposure 532 Radiation AccidentDispersed Exposure 538 Section Two Governmental Resources 79 State[books.google.com]
Dizziness
  • The combination of these effects can lead to hearing loss , tinnitus, headache, vertigo (dizziness), and difficulty processing sound. [4] In general, primary blast injuries are characterized by the absence of external injuries; thus internal injuries[en.wikipedia.org]

Workup

Victims of primary blast injuries must undergo immediate and urgent workup that consists of a complete physical exam including that of the ears. Often, patients require serial exams. Additionally, a thorough evaluation includes the appropriate studies as explained below.

Laboratory tests

Critical laboratory assessment includes a complete blood count (CBC) to measure hemoglobin and platelet count. Moreover, the patient should be screened for disseminated intravascular coagulation (DIC) with tests such as a coagulation panel, fibrinogen, and fibrin split products. Also, blood type and cross matching are obtained should the patient require transfusion. Urinalysis is also performed in patients with blast injuries.

If carbon monoxide poisoning is suspected, the patient should be tested for carboxyhemoglobin (HbCO) and analyzed for acid/base disturbance with an electrolyte panel and an arterial blood gas (ABG). The patient should be monitored with pulse oximetry. Cyanide poisoning should also be considered and investigated.

Imaging

Chest radiography is indicated in patients who have encountered overpressure trauma. Moreover, this modality is warranted for victims with respiratory manifestations, abnormal lung sounds, physical signs of chest trauma on inspection, and even patients with tympanic membrane rupture only. Confirmatory findings on chest radiography and computed tomography (CT) scan include the characteristic "butterfly" pattern, possibly pneumothorax, and opacities [6] [11].

Abdominal x-rays or CT is necessary for patients with abdominal pain, which may be preceded by a Focused Abdominal Sonography for Trauma (FAST) assessment. Ominous findings warrant emergency surgical exploration.

Other

Histological studies with immunohistochemical staining and scanning electron microscopy on sample lung tissue feature alveolar overdistension, perivascular hemorrhage, edema, and pulmonary fat embolism [9].

Rickettsia Prowazekii
  • prowazekii Attack Typhus Fever 627 Vibrio cholerae Cholera Attack 635 Salmonella Species Salmonellosis Attack 641 Burkholderia mallei Glanders Attack 647 Opioid Agent Attack 653 TickBorne Encephalitis Virus Attack 663 Viral Hemorrhagic Fever 671 Chikungunya[books.google.com]
Burkholderia Mallei
  • mallei Glanders Attack 647 Opioid Agent Attack 653 TickBorne Encephalitis Virus Attack 663 Viral Hemorrhagic Fever 671 Chikungunya Virus Attack 678 Influenza Virus Attack 684 Hantavirus Pulmonary Syndrome Attack 690 Section Ten Part Three Toxins 698[books.google.com]

Treatment

  • The results have a potential clinical application to improve the efficacy of treatment for blast injury patients.[ncbi.nlm.nih.gov]
  • Vigorous treatment of respiratory failure, early recognition, and prompt correction of hemostatic and electrolyte abnormalities may have contributed to the avoidance of fatalities among the five patients with severe blast injury.[ncbi.nlm.nih.gov]
  • Timely diagnosis and correct treatment result in excellent outcome.[ncbi.nlm.nih.gov]
  • METHOD: Patients from the intensive care unit (ICU) of the Role 3 Medical Treatment Facility at Camp Bastion, Helmand Province, Afghanistan were studied over a five month period commencing in 2012.[ncbi.nlm.nih.gov]

Prognosis

  • Specialty: Emergency Medicine, Pediatric Emergency Medicine, Pulmonary Disease, Orthopedic Trauma Surgery, Pediatric Emergency Medicine, Trauma Surgery Objective: severity, prognosis, stage ICD-10: X96 Description: The Blast Lung Injury (BLI) severity[medicalalgorithms.com]
  • With regards to the prognosis, one study reported that the majority of surviving victims in a bus bombing recovered pulmonary function at the one-year follow-up.[symptoma.com]
  • Among them, the acute prognosis (survival rates) and pathological injury score (blending area) were compared. The levels of albumin and MIP-2 in the bronchoalveloral lavage fluid (BALF) were measured after LISW in each group.[ahajournals.org]
  • Chest normal chest radiograph 4 pulmonary edema 4 usually, no evidence of interstitial infiltrates Treatment and prognosis Leukostasis is an emergency and commonly managed with leukapheresis to remove the excess of leukemic cells in circulation 4 . thoracic[radiopaedia.org]

Etiology

  • […] by , Last updated August 17, 2015 Reviewed and revised 17 August 2015 OVERVIEW Neurogenic pulmonary edema (NPE) is a clinical syndrome characterized by the acute onset of pulmonary edema following a significant central nervous system (CNS) insult The etiology[lifeinthefastlane.com]

Epidemiology

  • With contributions by experts from around the globe, the book covers topics such as the epidemiology of blast and explosion injury, pathology and pathophysiology, and the modeling and mechanism of injury.[books.google.com]
  • Military data have focused on PBLI characteristics following evacuation from the combat theatre; less is known about its immediate management and epidemiology in the deployed setting.[ncbi.nlm.nih.gov]
  • Blast injuries to the lung: epidemiology and management . Philos Trans R Soc Lond B Biol Sci 2011 ;366: 295 – 299 . Crossref , Medline , Google Scholar 7. Barnard E , Johnston A . Images in clinical medicine: blast lung .[atsjournals.org]
  • Retrospective database analyses were undertaken to establish the epidemiology of blast lung injury in the military patient population, and the use of rFVIIa within military hospitals.[theses.ncl.ac.uk]
  • The epidemiology of blast lung injury during recent military conflicts: a retrospective database review of cases presenting to deployed military hospitals, 2003–2009. Philos Trans R Soc Lond B Biol Sci. 2011;366(1562):291–4.[link.springer.com]
Sex distribution
Age distribution

Pathophysiology

  • With contributions by experts from around the globe, the book covers topics such as the epidemiology of blast and explosion injury, pathology and pathophysiology, and the modeling and mechanism of injury.[books.google.com]
  • REVIEW ARTICLE Year : 2014 Volume : 16 Issue : 2 Page : 101-105 Pathophysiology and management of blast lung injury 1 Sr Adv (Surgery & Cardiothoracic Surgery), INHS Asvini, Colaba, Mumbai - 05, India 2 Sr Adv (Anaesthesiology & Cardiothoracic Anaesthesia[marinemedicalsociety.in]
  • A recent thorough review of blast-related lung injury, including pathophysiology, epidemiology, evaluation, and management. Google Scholar 24. Avidan V, Hersch M, Armon Y, et al. Blast lung injury: clinical manifestations, treatment, and outcome.[link.springer.com]
  • Pathophysiology Blast injuries include both physical and psychologic trauma.[merckmanuals.com]
  • Horrocks CL: Blast injuries: Biophysics, pathophysiology and management principles. JR Army Med Corps 2001;147:28-40. Kluger et al: The special injury pattern in terrorist bombings. Journal of the American College of Surgeons 2004;199(6):875-879.[emdocs.net]

Prevention

  • What action should be performed to prevent the spread of the contaminants? A) Floors must be scrubbed with undiluted bleach. You've reached the end of this preview.[coursehero.com]
  • Dr Arora with expertise in blast loading on composite structures will be presenting his current research work in improving the prevention and treatment of lung injuries via the use of engineering methods.[nearyou.imeche.org]
  • Clinical interventions All patients with suspected or confirmed BLI should receive supplemental high flow oxygen sufficient to prevent hypoxemia (delivery may include non-rebreather masks, continuous positive airway pressure, or endotracheal intubation[slideplayer.com]
  • Your doctor may prescribe blood thinners for six months or longer to prevent additional clots from forming.[nyulangone.org]
  • Session 2 included a range of presentations focused on blast lung injury and preventing and treating heterotopic ossification.[blastinjury.org.uk]

References

Article

  1. Cooper GJ, Maynard RL, Cross NL, Hill JF. Casualties from terrorist bombings. J Trauma.1983;23(11):955–967.
  2. Mayorga MA. The pathology of primary blast overpressure injury. Toxicology.1997;121(1):17–28.
  3. Phillips YY. Primary blast injuries. Ann Emerg Med. 1986;15(12):1446–1450.
  4. Leibovici D, Gofrit ON, Stein M, et al. Blast injuries: bus versus open-air bombings. A comparative study of injuries in survivors of open-air versus confined-space explosions. J Trauma. 1996;41(6):1030–1035.
  5. Katz E, Ofek B, Adler J, Abramowitz HB, Krausz MM. Primary blast injury after a bomb explosion in a civilian bus. Ann Surg 1989;209(4):484–488.
  6. Pizov R, Oppenheim-Eden A, Matot I, et al. Blast lung injury from an explosion on a civilian bus. Chest. 1999;115(1):165–172.
  7. Hirshberg B, Oppenheim-Eden A, Pizov R, et al. Recovery from blast lung injury: one-year follow-up. Chest. 1999;116(6):1683–1688.
  8. Mudd KL, Hunt A, Matherly RC, et al. Analysis of pulmonary fat embolism in blunt force fatalities. J Trauma. 2000;48(4):711–715.
  9. Tsokos M, Paulsen F, Petri S, Madea B, Puschel K, Turk EE. Histologic, immunohistochemical, and ultrastructural findings in human blast lung injury. Am J Respir Crit Care Med. 2003;168(5):549–555.
  10. Aboudara M, Mahoney PF, Hicks B, Cuadrado D. Primary blast lung injury at a NATO Role 3 hospital. J R Army Med Corps. 2014;160(2):161–166.
  11. Barnard E, Johnston A. Blast Lung. N Engl J Med. 2013; 368(11):1045.

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Last updated: 2017-08-09 17:54