Injuries From Explosions: Physics, Biophysics, Pathology, and Required Research Focus

Champion, Howard R.; Holcomb, John B.; Young, Lee Ann

doi:10.1097/ta.0b013e3181a27e7f

Cited by 297 publications

(216 citation statements)

References 22 publications

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“…Currently, a high proportion of military battlefield injuries are the consequence of explosive events, e.g. detonation of IEDs [11,19], with recent reports indicating that 70-80% of casualties result from explosions. There are also instances of civilians being injured by explosives, with mass casualties resulting from terrorist attacks [9,10,20,21].…”

Section: Forward (Pre-hospital) Resuscitationmentioning

confidence: 99%

Blast injury research models

Kirkman

Watts

Cooper

2011

Phil. Trans. R. Soc. B

106

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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: Forward (Pre-hospital) Resuscitationmentioning

confidence: 99%

Blast injury research models

Kirkman

Watts

Cooper

2011

Phil. Trans. R. Soc. B

106

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“…Burn-blast combined injury is one of the common injuries both during war and peacetime. Even in local military conflicts, explosives are used as the main offensive weapon and are often accompanied by burning, which contributes to the increased morbidity of burn-blast combined injury [4,17,18]. About 35,000 cases were attributed to explosions during the war in Iraq and Afghanistan [19].…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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“…The lethal radius of fragments generated from the explosion of standard artillery rounds exceeds by an order of magnitude that of primary blast injuries [17]. While these notions could help further limit the problem space for bTBI, the development of high-performance personal protective equipment (PPE) makes a considerable difference in defeating ballistic threats as well as significantly increasing the injury thresholds for primary blast injury to the lung [18]. As such, it is more conservative not to further limit the problem space based on other threats, which may or may not be survivable.…”

Section: Relevant Exposure and Loading Conditionsmentioning

confidence: 99%