Tissues at Risk From Blast Injuries

Tissues at risk from blast injuries

Hollow organs such as the middle ear, lungs, and gastrointestinal tract are most susceptible to pressure changes.

Middle ear injuries

Rupture of the tympanic membrane can occur at 5 to 7 pounds per square inch above atmospheric pressure.

Middle ear injury symptoms

Patients may report ringing, ear pain, hearing loss, and blood in the ear canal.

Ossicle dislocation

Structural components of the inner ear, such as the ossicles, may be dislocated.

Middle ear injury significance

Indicates risk of pressure injuries to the lungs.

Pulmonary blast injuries

Lung trauma including contusions and hemorrhages caused by short-range explosive exposure.

Open-space blast lung injuries

Both lungs are usually injured when the explosion occurs in an open space.

Primary blast lung injury recognition

May produce no external signs, making it easy to miss in patients.

Pulmonary blast injury symptoms

Chest tightness or pain, hemoptysis, tachypnea, and other respiratory distress signs.

Subcutaneous emphysema

Crackling under the skin detected by palpation, indicating air in the thorax.

Pneumothorax

A common pulmonary blast injury that may require emergency decompression in the field.

Pulmonary edema

May develop rapidly after blast lung injury.

Oxygen administration in blast lung injury

Provide oxygen to maintain SaO2 of 94%–99%; avoid positive-pressure oxygen.

Arterial air embolism

A severe pulmonary blast injury where alveolar disruption allows air into the pulmonary vasculature.

Air embolism cardiac risk

Even small air bubbles can enter coronary arteries and cause myocardial injury.

Air embolism cerebrovascular risk

Air emboli in the brain can produce visual disturbances, behavioral changes, altered consciousness, and other neurologic signs.

Petechiae to large hematomas in patients with blast injuries

Possible skin findings ranging from small pinpoint hemorrhages to large bruising.

Perforation or rupture of the bowel and colon is possible

A potential internal injury from blast forces, particularly underwater explosions.

Underwater explosions result in the most severe abdominal injuries

The mechanism causing the most serious damage to abdominal organs due to blast wave transmission in water.

Subarachnoid and subdural hematomas are often seen

Common types of brain bleeding associated with blast injuries and head trauma.

Permanent or transient neurologic deficits may occur

Possible outcomes from blast-related concussion, intracerebral bleeding, or air embolism.

Instant but transient unconsciousness, with or without retrograde amnesia

A potential immediate effect initiated by head trauma or cardiovascular problems from a blast.

Bradycardia and hypotension are common

Vital sign abnormalities often seen after an intense pressure wave from an explosion.

Traumatic amputation by the post-blast wind

An injury indicating the patient is likely to sustain other fatal injuries secondary to the blast.

Body armor may limit shrapnel but increase spine injury risk

Protective gear that catches more blast wave energy, increasing potential for spine and spinal cord injury