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.

• Pain

  vomiting blood, rectal pain, testicular pain, unexplained hypovolemia, abdominal distention, and/or rigidity. [statpearls.com]

  Expensive, custom-made prosthetics stopped fitting after months or a year’s worth of normal use, and stumps became malformed due to pain and swelling. [knowitwall.com]

  nausea, vomiting, hematemesis, rectal pain, tenesmus, testicular pain, unexplained hypovolemia Clinical signs can be initially subtle until acute abdomen or sepsis is advanced 12 Ear Injury Tympanic membrane most common primary blast injury Signs of [slideplayer.com]

  Pain is likely, but is acute rather than chronic. Fluid volume excess is unlikely to be a priority diagnosis and cardiac output will be secondarily affected by the pulmonary effects. Subscribe to view the full document. 36. [coursehero.com]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: December 5, 2022 [patientslikeme.com]

• 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 Virus Attack 678 Influenza [books.google.com]

  A) Watchful waiting B) Treatment with colony-stimulating factors (CSFs) C) Vaccination D) Treatment with ceftriaxone Ans: C Feedback: All people who have had household or face-to-face contact with a patient with small pox after the fever begins should [coursehero.com]

  FEATURES Types early – minutes to hours after CNS insult delayed – 12 to 24 hours after CNS insult Features highly variable mild SOB -> acute fulminating pulmonary oedema (acutely dyspneic, tachypneic, and hypoxic within minutes) sympathetic surge: fever [lifeinthefastlane.com]

  Clinically, patients present with a sudden onset of progressive dyspnea, a nonproductive cough, a fever, and hypoxia. [pubs.rsna.org]

  cough, sputum, and/or neutropenia Segmental or lobar consolidation Fungal pneumonia Post chemotherapy with neutropenia, fever, hemoptysis Halo sign, segmental or subsegmental pleura-based consolidation, cavitation centrilobular nodules, fungal ball, [pulmonarychronicles.com]

• Inflammation

  The computerised model can simulate complete body systems, including reactions to the excess fluid that accumulates after injury or inflammation. [medicaldevice-network.com]

  In the normal physiological state, the body is in a dynamic balance between pro-inflammaton and anti-inflammation, oxidation and anti-oxidation, promoting apoptosis and inhibiting apoptosis. [pesquisa.bvsalud.org]

  RESULTS: Lung histology confirmed pulmonary barotrauma and inflammation. This was associated with rises in CXCL-1, IL-6, TNF-α and albumin protein in the BALF. [spiral.imperial.ac.uk]

  The controlled accumulation of fibroblasts to sites of inflammation is crucial to effective tissue repair after injury [1]. Either inadequate or excessive accumulation of fibroblasts could result in abnormal tissue function. [primarycell.com]

  Attenuation of pulmonary inflammation after exposure to blast overpressure by N-acetylcysteine amide. Shock. 2009 Sep;32(3):325–31. CrossRef CAS Google Scholar Mackenzie IM, Tunnicliffe B. Blast injuries to the lung: epidemiology and management. [link.springer.com]

• Unconsciousness

  On scene, the patient was found unconscious with bilateral amputations above wrist, was blind from both eyes and had denudation of subcutaneous tissue of the anterior thoracic wall probably from shrapnel. [casereports.bmj.com]

  These pathological findings of brain injury can result in a spectrum of acute clinical presentations ranging from mild concussion, to focal neurological findings, to unconsciousness, coma and death. [brainline.org]

  Use of diffusion-weighted MRI in the emergency department for unconscious trauma patients with negative brain CT. Emerg Med J 2010 ;27: 131 – 32. Google Scholar | Crossref | Medline 52. Mimoz, O, Edouard, A, Beydon, L. [journals.sagepub.com]

  In the setting of this series of cases symptoms of chest pain and dyspnoea were not recorded and would, in any case, have been impossible to disentangle from similar symptoms arising from other injuries, shock or, in the case of patients who were unconscious [ncbi.nlm.nih.gov]

  Second, the patient may be unconscious, making the value of serial examinations limited. Third, diagnostic examinations, although useful for detecting hemorrhage, may be misleading or insensitive in the early stages of perforation. [archive.ahrq.gov]

• Weakness

  Therapy focuses on strength and mobility training, as well as breathing exercises to minimize weakness and shortness of breath due to pulmonary embolism. [nyulangone.org]

  […] not include history of loss of consciousness Headache, seizures, dizziness, memory problems Gait/balance problems, nausea/vomiting, difficulty concentrating Visual disturbances, tinnitus, slurred speech Disoriented, irritability, confusion Extremity weakness [brainline.org]

  Vague symptoms of fatigue and weakness may also be the presenting manifestations of pulmonary complications. Presentations of some specific conditions are listed below. [clinicaladvisor.com]

• Cough

  Blast lung should be suspected if the patient presents with difficulty breathing, shortness of breath, cough, coughing up blood, chest pain and low oxygen levels. On chest x-ray a distinctive butterfly pattern can be seen. [redwoodsmedicaledge.com]

  D) Encourage the patient to perform deep breathing and coughing exercises. [coursehero.com]

  Patients may present with a variety of symptoms, including dyspnea, chest pain, cough, and hemoptysis. Physical examination may reveal tachypnea, hypoxia, cyanosis, and decreased breath sounds. [ncbi.nlm.nih.gov]

  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). [symptoma.com]

  Shock, dyspnea, restlessness, cyanosis, cough, and expectoration are among the more usual symptoms (4, 8, 15). Most of the victims also have ruptured ear drums, and occasionally there are signs of intra-abdominal hemorrhage. [pubs.rsna.org]

• Dyspnea

  Patients may present with a variety of symptoms, including dyspnea, chest pain, cough, and hemoptysis. Physical examination may reveal tachypnea, hypoxia, cyanosis, and decreased breath sounds. [ncbi.nlm.nih.gov]

  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). [symptoma.com]

  Shock, dyspnea, restlessness, cyanosis, cough, and expectoration are among the more usual symptoms (4, 8, 15). Most of the victims also have ruptured ear drums, and occasionally there are signs of intra-abdominal hemorrhage. [pubs.rsna.org]

  INSTRUCTIONS Use in patients who have sustained blast injury and have respiratory symptoms (e.g. cough, cyanosis, dyspnea, hemoptysis). [mdcalc.com]

  It needs to be considered in any patient with myelogenic leukemia with acute onset dyspnea and normal chest radiograph or evident pulmonary edema. Symptoms are due to small pulmonary vessels or coronary artery obstruction by leukemic cells. [radiopaedia.org]

• Hemoptysis

  Patients with massive hemoptysis or significant air leaks may benefit from selective bronchus intubation. Clinical evidence of or suspicion for a hemothorax or pneumothorax warrants prompt decompression. [slideplayer.com]

  Patients may present with a variety of symptoms, including dyspnea, chest pain, cough, and hemoptysis. Physical examination may reveal tachypnea, hypoxia, cyanosis, and decreased breath sounds. [ncbi.nlm.nih.gov]

  INSTRUCTIONS Use in patients who have sustained blast injury and have respiratory symptoms (e.g. cough, cyanosis, dyspnea, hemoptysis). [mdcalc.com]

  </li></ul><ul><li>Impending airway compromise, secondary edema, injury, or massive hemoptysis requires immediate intervention to secure the airway. [slideshare.net]

  Blast lung should be suspected for anyone with dyspnea, cough, hemoptysis, or chest pain following blast exposure. Blast lung produces a characteristic “butterfly” pattern on a chest X-ray. [ccnmtl.columbia.edu]

• Tachypnea

  Physical examination may reveal tachypnea, hypoxia, cyanosis, and decreased breath sounds. [ncbi.nlm.nih.gov]

  Signs: tachypnea, hypoxia, cyanosis, apnea, wheezing, decreased breath sounds, and hemodynamic instability. Associated pathology: bronchopleural fistula, air emboli, and hemothoraces or pneumothoraces. [slideplayer.com]

  Blast lung injury may cause dyspnea, hemoptysis, cough, chest pain, tachypnea, wheezing, decreased breath sounds, apnea, hypoxia, cyanosis, and hemodynamic instability. [msdmanuals.com]

  After stabilization, evaluation of those organ systems specifically affected by blast injury should be initiated. 20 Blast lung injury can be diagnosed on repeat physical exam by looking for tachypnea, respiratory distress, hemoptysis, hypoxia, etc. 9 [emdocs.net]

• Decreased Breath Sounds

  Physical examination may reveal tachypnea, hypoxia, cyanosis, and decreased breath sounds. [ncbi.nlm.nih.gov]

  Signs: tachypnea, hypoxia, cyanosis, apnea, wheezing, decreased breath sounds, and hemodynamic instability. Associated pathology: bronchopleural fistula, air emboli, and hemothoraces or pneumothoraces. [slideplayer.com]

  Blast lung injury may cause dyspnea, hemoptysis, cough, chest pain, tachypnea, wheezing, decreased breath sounds, apnea, hypoxia, cyanosis, and hemodynamic instability. [msdmanuals.com]

• Chest Pain

  Patients may present with a variety of symptoms, including dyspnea, chest pain, cough, and hemoptysis. Physical examination may reveal tachypnea, hypoxia, cyanosis, and decreased breath sounds. [ncbi.nlm.nih.gov]

  Blast lung should be suspected if the patient presents with difficulty breathing, shortness of breath, cough, coughing up blood, chest pain and low oxygen levels. On chest x-ray a distinctive butterfly pattern can be seen. [redwoodsmedicaledge.com]

  Victims can have chest pain, tachycardia, decreased pulse pressure, cardiac dysrhythmias and/or hypotension as a result of heart involvement. [statpearls.com]

  […] ray 5 Clinical Presentation Symptoms : dyspnea, hemoptysis, cough, and chest pain. [slideplayer.com]

  Blast lung should be suspected for anyone with dyspnea, cough, hemoptysis, or chest pain following blast exposure. Blast lung produces a characteristic “butterfly” pattern on a chest X-ray. [ccnmtl.columbia.edu]

• Cyanosis

  Physical examination may reveal tachypnea, hypoxia, cyanosis, and decreased breath sounds. [ncbi.nlm.nih.gov]

  Shock, dyspnea, restlessness, cyanosis, cough, and expectoration are among the more usual symptoms (4, 8, 15). Most of the victims also have ruptured ear drums, and occasionally there are signs of intra-abdominal hemorrhage. [pubs.rsna.org]

  INSTRUCTIONS Use in patients who have sustained blast injury and have respiratory symptoms (e.g. cough, cyanosis, dyspnea, hemoptysis). [mdcalc.com]

  Signs: tachypnea, hypoxia, cyanosis, apnea, wheezing, decreased breath sounds, and hemodynamic instability. Associated pathology: bronchopleural fistula, air emboli, and hemothoraces or pneumothoraces. [slideplayer.com]

• Otalgia

  Signs of ear injury are usually present at time of initial evaluation and should be suspected for anyone presenting with hearing loss, tinnitus, otalgia, vertigo, bleeding from the external canal, TM rupture, or mucopurulent otorrhea. [ccnmtl.columbia.edu]

  […] pain, unexplained hypovolemia Clinical signs can be initially subtle until acute abdomen or sepsis is advanced 12 Ear Injury Tympanic membrane most common primary blast injury Signs of ear injury usually evident on presentation (hearing loss, tinnitus, otalgia [slideplayer.com]

  Otalgia. Tympanic perforation. Ossicular chain disruption. Ossicular chain fracture. Labyrinthine fistula. Perilymphatic fistula. Loss of hair cell integrity. Conductive hearing loss. Sensory hearing loss. Basilar membrane rupture. [archive.ahrq.gov]

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].

• Air Bronchogram

  […] and perihilar and lower lobe consolidation also with air-bronchogram in the right lung. [casereports.bmj.com]

  Chest radiography (Panel A) and computed tomography (Panel B) revealed typical appearances of blast lung (pulmonary barotrauma), with interstitial and alveolar filling defects and prominent air bronchograms in a “butterfly” pattern. [nejm.org]

  No frank air bronchograms were seen. There was no radiologic evidence of hemothorax or pneumothorax, no rib fractures, and no free subdiaphragmatic gas. [More] [Minimize] Figure 2. [atsjournals.org]

• Hypercapnia

  High flow oxygen, airway management, tube thoracostomy in the setting of pneumothoraces, mechanical ventilation (when required) with permissive hypercapnia, and judicious fluid administration are essential components in the management of blast lung injury [ncbi.nlm.nih.gov]

  […] journal of the National Association of EMS Physicians and the National Association of State EMS Directors 2006 High flow oxygen, airway management, tube thoracostomy in the setting of pneumothoraces, mechanical ventilation (when required) with permissive hypercapnia [semanticscholar.org]

  Despite aggressive treatment that included carefully monitored fluid resuscitation with a pulmonary catheter and optimisation of patient’s physiological respiratory status with pressure-limited, volume-controlled ventilation with permissive hypercapnia [casereports.bmj.com]

“A computerised model allows us to run as many treatment trials as we need to for any type of scenario quickly.” [medicaldevice-network.com]

The results have a potential clinical application to improve the efficacy of treatment for blast injury patients. [hanyang.elsevierpure.com]

The common clinical manifestation, diagnosis, and therapeutic criteria of PBI were further introduced regarding the precision diagnosis and individualizing treatment. [link.springer.com]

Specialty: Orthopedic Surgery, Sports Medicine & Rehabilitation Emergency Medicine & Critical Care Emergency Medicine & Critical Care General Surgery & Anesthesiology Objective: severity, prognosis, stage ICD-10: X96 Description: The Blast Lung Injury [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. [circ.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 With detonation of a bomb, gases are rapidly produced within an enclosed space at excessively high pressure— as much as 100 to 650 tons per square inch. [pubs.rsna.org]

[…] 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]

In the current military conflict in Iraq and Afghanistan, blast injury overwhelmingly is the most common wound etiology, and the incidence of survivors with brain injury has increased. [brainline.org]

Transfusion-related acute lung injury: epidemiology and a prospective analysis of etiologic factors. Blood 2003 ;101: 454 – 62. Google Scholar | Crossref | Medline | ISI 84. Ozier, Y, Muller, JY, Mertes, PM. [journals.sagepub.com]

Presently, some new findings in the epidemiology, injury mechanism, diagnosis, and therapeutics have been given. [link.springer.com]

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]

We therefore reviewed the epidemiology, pathophysiology and treatment of primary blast lung injury. [urgentiegeneeskunde.com]

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]

Using this platform, we can, to some extent, simulate the pathophysiological consequences of blast lung. [epj-conferences.org]

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]

We therefore reviewed the epidemiology, pathophysiology and treatment of primary blast lung injury. [urgentiegeneeskunde.com]

Finally, based on the idea that any efficient prevention is superior to excellent remedy, the preventive measures of PBLI were extensively discussed. [link.springer.com]

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]

© 2005 Centers for Disease Control and Prevention (CDC) Cite this: Notice to Readers: Blast Lung Injury: What Clinicians Need to Know - Medscape - Jul 29, 2005. [medscape.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]

Date 2 May 2013, 22:04:44 Source http://www.bt.cdc.gov/masscasualties/blastlunginjury_prehospital.asp Author Centers for Disease Control and Prevention Licensing [ edit ] Original upload log [ edit ] Date/Time Dimensions User Comment 3 May 2013, 02:07 [commons.wikimedia.org]

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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.
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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.