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Korkmaz İ, Çelikkaya ME. Blast Lung Injury in Children: Injury Patterns and Associated Organ Injuries. Pediatr Emerg Care 2023; 39:715-720. [PMID: 37463251 DOI: 10.1097/pec.0000000000003021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Bombings are the most common cause of civilian deaths in wars, and unfortunately, a large proportion of civilian victims are children. OBJECTIVE This study aimed to evaluate the frequency of blast lung injury (BLI), to evaluate lung injury patterns on tomographic images, and to document the relationship between blast lung and mortality in children exposed to the blast effect. METHODS Thirty-six children (25.3% of pediatric patients brought to our hospital with blast injury) with BLI were included in the study. The pediatric trauma score evaluations made in the emergency department in the first admission were recorded. Lung injury findings in the computed tomography images of the patients were examined, and injuries detected in other systems were recorded. RESULTS The most common lung injury pattern was contusion (right: 69.4%, left: 80.6%). The incidence of brain damage (52.4%) and intra-abdominal injury (76.2%) in children with low pediatric trauma score value was statistically significantly higher ( P = 0.049, P = 0.017, respectively). There was no statistically significant correlation between the presence of lung injury, injury patterns, and mortality. The incidence of brain damage in deceased patients (61.5%) was statistically significantly higher than the incidence of brain damage in surviving patients (26.1%) ( P = 0.036). Low pediatric trauma score was observed in 11 (84.6%) of the deceased children and in 10 (43.5%) of the survivors ( P = 0.016). The mean age of children with hemothorax in the right lung was statistically significantly lower than those without ( P = 0.014). CONCLUSION Our findings revealed that pediatric BLI is common after a blast, that it is associated with other system injuries, and that a multimodal radiological approach is required in child victims.
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Affiliation(s)
| | - Mehmet Emin Çelikkaya
- Pediatric Surgery, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, Turkey
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2
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Bukowski J, Nowadly CD, Schauer SG, Koyfman A, Long B. High risk and low prevalence diseases: Blast injuries. Am J Emerg Med 2023; 70:46-56. [PMID: 37207597 DOI: 10.1016/j.ajem.2023.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/29/2023] [Accepted: 05/02/2023] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION Blast injury is a unique condition that carries a high rate of morbidity and mortality, often with mixed penetrating and blunt injuries. OBJECTIVE This review highlights the pearls and pitfalls of blast injuries, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Explosions may impact multiple organ systems through several mechanisms. Patients with suspected blast injury and multisystem trauma require a systematic evaluation and resuscitation, as well as investigation for injuries specific to blast injuries. Blast injuries most commonly affect air-filled organs but can also result in severe cardiac and brain injury. Understanding blast injury patterns and presentations is essential to avoid misdiagnosis and balance treatment of competing interests of patients with polytrauma. Management of blast victims can also be further complicated by burns, crush injury, resource limitation, and wound infection. Given the significant morbidity and mortality associated with blast injury, identification of various injury patterns and appropriate management are essential. CONCLUSIONS An understanding of blast injuries can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Josh Bukowski
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Craig D Nowadly
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - Steven G Schauer
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX; Brooke Army Medical Center, JBSA Fort Sam Houston, TX, USA.
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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3
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Deng M, He J, Hao C, Guo Y, Si H, Deng X, Zhang C, Li S, Yao S, Ren W, Yao W. EFFECT OF EXOSOMES DERIVED FROM BONE MARROW MESENCHYMAL STEM CELLS ON PROGRAMMED CELL DEATH IN BLAST-INDUCED LUNG INJURY IN RATS. Shock 2023; 59:955-965. [PMID: 37119808 DOI: 10.1097/shk.0000000000002128] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
ABSTRACT Blast lung injuries (BLIs) are frequent because of industrial accidents and terrorist groups. Bone marrow mesenchymal stem cells (BMSCs) and exosomes derived from BMSCs (BMSCs-Exo) have become a hot topic in modern biology because of their significance in damage healing, immune regulation, and gene therapy. The aim of this study is to investigate the effect of BMSCs and BMSCs-Exo on BLI in rats caused by gas explosion. Here, BMSCs and BMSCs-Exo were transplanted into BLI rats via tail vein and then evaluated pathological alterations, oxidative stress, apoptosis, autophagy, and pyroptosis in the lung tissue. Through histopathology and changes in malondialdehyde (MDA) and superoxide dismutase (SOD) contents, we discovered that oxidative stress and inflammatory infiltration in the lungs were significantly reduced by BMSCs and BMSCs-Exo. After treatment with BMSCs and BMSCs-Exo, apoptosis-related proteins, such as cleaved caspase-3 and Bax, were significantly decreased, and the ratio of Bcl-2/Bax was significantly increased; the level of pyroptosis-associated proteins, including NLRP3, GSDMD-N, cleaved caspase-1, IL-1β, and IL-18, were decreased; autophagy-related proteins, beclin-1 and LC3, were downregulated while P62 was upregulated; the number of autophagosomes was decreased. In summary, BMSCs and BMSCs-Exo attenuate BLI caused by gas explosion, which may be associated with apoptosis, aberrant autophagy, and pyroptosis.
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Affiliation(s)
- Meng Deng
- Department of Occupational Health and Environmental Health, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Jing He
- Department of Occupational Health and Environmental Health, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Changfu Hao
- Department of Child and Adolescence Health, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yonghua Guo
- Department of Occupational Health and Environmental Health, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Huifang Si
- Department of Occupational Health and Environmental Health, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xuedan Deng
- Department of Occupational Health and Environmental Health, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Chengpeng Zhang
- Department of Occupational Health and Environmental Health, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Shiyu Li
- Department of Occupational Health and Environmental Health, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Sanqiao Yao
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Wenjie Ren
- Xinxiang Medical University, Xinxiang, China
| | - Wu Yao
- Department of Occupational Health and Environmental Health, College of Public Health, Zhengzhou University, Zhengzhou, China
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Hazell GA, Pearce AP, Hepper AE, Bull AMJ. Injury scoring systems for blast injuries: a narrative review. Br J Anaesth 2021; 128:e127-e134. [PMID: 34774294 DOI: 10.1016/j.bja.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/10/2021] [Accepted: 10/03/2021] [Indexed: 11/25/2022] Open
Abstract
Injury scoring systems can be used for triaging, predicting morbidity and mortality, and prognosis in mass casualty incidents. Recent conflicts and civilian incidents have highlighted the unique nature of blast injuries, exposing deficiencies in current scoring systems. Here, we classify and describe deficiencies with current systems used for blast injury. Although current scoring systems highlight survival trends for populations, there are several major limitations. The reliable prediction of mortality on an individual basis is inaccurate. Other limitations include the saturation effect (where scoring systems are unable to discriminate between high injury score individuals), the effect of the overall injury burden, lack of precision in discriminating between mechanisms of injury, and a lack of data underpinning scoring system coefficients. Other factors influence outcomes, including the level of healthcare and the delay between injury and presentation. We recommend that a new score incorporates the severity of injuries with the mechanism of blast injury. This may include refined or additional codes, severity scores, or both, being added to the Abbreviated Injury Scale for high-frequency, blast-specific injuries; weighting for body regions associated with a higher risk for death; and blast-specific trauma coefficients. Finally, the saturation effect (maximum value) should be removed, which would enable the classification of more severe constellations of injury. An early accurate assessment of blast injury may improve management of mass casualty incidents.
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Affiliation(s)
- George A Hazell
- Centre for Blast Injury Studies, Imperial College London, London, UK.
| | - A Phill Pearce
- Department of General Surgery, The Royal London Hospital, Barts NHS Trust, London, UK
| | - Alan E Hepper
- Defence Science and Technology Laboratory, Porton Down, Salisbury, UK
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Imperial College London, London, UK
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5
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Moga HK, Parmar AP, Gohil ND. An autopsy case of death due to AC compressor blast - A rare case illustrating primary, secondary, tertiary & quaternary blast injuries. J Forensic Leg Med 2021; 80:102173. [PMID: 33895542 DOI: 10.1016/j.jflm.2021.102173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022]
Abstract
Blast injuries seen in various accidents involving pressurized containers like gas cylinders, tires, et cetera, and acts of terrorism. The associated factors can vary from poor handling of equipment to inadequate safety precautions. These injuries include a variety of injuries, such as, injuries due to shock wave, burns, fractures, et cetera, involving multi-organ systems, especially lungs and hollow organs, due to the high-pressurized shock wave. The presented case is of the death of a 24-years-old male as a result of a blast of the compressor present in the AC outdoor unit during the filling of the gas. Here, the body showed injuries due to shock wave, secondary impact, tertiary impact because of fall on the ground, and quaternary injuries due to burns. The cause of death was Blast lung associated with Subarachnoid hemorrhage.
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Affiliation(s)
- Hemal K Moga
- Government Medical College & Sir Takhtasinhji General Hospital, Department of Forensic Medicine & Toxicology, Near State Transport Bus Station, Bhavnagar, Gujarat, 364002, India.
| | - Amit P Parmar
- Government Medical College & Sir Takhtasinhji General Hospital, Department of Forensic Medicine & Toxicology, Near State Transport Bus Station, Bhavnagar, Gujarat, 364002, India.
| | - Neha D Gohil
- Sir Takhtasinhji General Hospital, Near District Jail, Bhavnagar, Gujarat, 364002, India.
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6
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Management of combined massive burn and blast injury: A 20-year experience. Burns 2019; 46:75-82. [PMID: 31852619 DOI: 10.1016/j.burns.2018.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 11/07/2018] [Accepted: 11/17/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Blast injuries are complex types of physical trauma resulting from direct or indirect exposure to an explosion, which can be divided into four classes: primary, secondary, tertiary, and quaternary. Primary blast injury results in damage, principally, in gas-containing organs such as the lungs (blast lung injury, BLI). BLI is defined as radiological and clinical evidence of acute lung injury occurring within 12h of exposure to an explosion and not due to secondary or tertiary injury. BLI often combines with cutaneous thermal injury, a type of quaternary blast injury, either in terrorist bomb attacks or in civilian accidental explosions. This report summarizes our experience in the management of combined massive burn and BLI at a Shanghai Burn Center in China. METHODS A retrospective observational analysis of clinical data was performed for massive burn patients with or without BLI during a 20-year interval. Patient characteristics, causes of injury, clinical parameters, management, and outcomes were recorded and evaluated. RESULTS A total of 151 patients (120 males and 31 females) with severe burn injury (≥50% TBSA) treated at the Burn Center of Changhai Hospital in Shanghai between July 1997 and June 2017 were enrolled in this study. Their mean age was 38.6±17.8 (3-75) years. Among them, 28 patients had combined BLI and burn injury and 39 patients had no BLI or smoke inhalation injury (non-BLI-SII). No significant difference was observed in the burn area or full-thickness burn area between the two groups. The lowest PaO2/fraction of inspired oxygen (FiO2) ratio during the first 24h in BLI patients was significantly lower than that in non-BLI-SII patients. Exudative changes were observed by X-ray radiography in all BLI patients but not in non-BLI-SII patients within 6h after injury. A significantly higher proportion of colloids were used for fluid resuscitation in BLI patients than that in non-BLI-SII patients. A higher proportion and longer time of mechanical ventilation were needed for BLI patients than those for non-BLI-SII patients, and a higher proportion of patients received sedative agents in the BLI group than those in the non-BLI-SII group. The first escharectomy was performed relatively later in BLI patients than in non-BLI-SII patients because of more time taken by BLI patients to recover from lung injury. The length of ICU and hospital stay in BLI patients was significantly longer than that in non-BLI-SII patients. No significant difference in the overall mortality was detected between these two groups. CONCLUSION It is a formidable challenge for clinicians to diagnose and manage massive burn patients combined with BLI. A comprehensive treatment approach is strongly recommended, including fluid resuscitation, airway management, mechanical ventilation, and surgical treatment. Given the high mortality of massive burn patients combined with BLI even in a recognized burn center, more prospective studies are encouraged to assess more effective strategies for the treatment of such patients.
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Herrmann J, Tawhai MH, Kaczka DW. Computational Modeling of Primary Blast Lung Injury: Implications for Ventilator Management. Mil Med 2019; 184:273-281. [PMID: 30901433 DOI: 10.1093/milmed/usy305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/27/2018] [Accepted: 10/18/2018] [Indexed: 01/02/2023] Open
Abstract
Primary blast lung injury (PBLI) caused by exposure to high-intensity pressure waves is associated with parenchymal tissue injury and severe ventilation-perfusion mismatch. Although supportive ventilation is often required in patients with PBLI, maldistribution of gas flow in mechanically heterogeneous lungs may lead to further injury due to increased parenchymal strain and strain rate, which are difficult to predict in vivo. In this study, we developed a computational lung model with mechanical properties consistent with healthy and PBLI conditions. PBLI conditions were simulated with bilateral derecruitment and increased perihilar tissue stiffness. As a result of these tissue abnormalities, airway flow was heterogeneously distributed in the model under PBLI conditions, during both conventional mechanical ventilation (CMV) and high-frequency oscillatory ventilation. PBLI conditions resulted in over three-fold higher parenchymal strains compared to the healthy condition during CMV, with flow distributed according to regional tissue stiffness. During high-frequency oscillatory ventilation, flow distribution became increasingly heterogeneous and frequency-dependent. We conclude that the distribution and rate of parenchymal distension during mechanical ventilation depend on PBLI severity as well as ventilatory modality. These simulations may allow realistic assessment of the risks associated with ventilator-induced lung injury following PBLI, and facilitate the development of alternative lung-protective ventilation modalities.
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Affiliation(s)
- Jacob Herrmann
- Department of Anesthesia, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA.,Department of Biomedical Engineering, University of Iowa, 5601 Seamans Center for the Engineering Arts and Sciences, Iowa City, IA
| | - Merryn H Tawhai
- Auckland Bioengineering Institute, University of Auckland, 6/70 Symonds St, Grafton, Auckland 1010, New Zealand
| | - David W Kaczka
- Department of Anesthesia, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA.,Department of Biomedical Engineering, University of Iowa, 5601 Seamans Center for the Engineering Arts and Sciences, Iowa City, IA.,Department of Radiology, University of Iowa Hospitals and Clinics, 3970 John Pappajohn Pavilion, 200 Hawkins Dr, Iowa City, IA
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8
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Kao RL, Huang W, Martin CM, Rui T. The effect of aerosolized indomethacin on lung inflammation and injury in a rat model of blunt chest trauma. Can J Surg 2019; 61:S208-S218. [PMID: 30418008 DOI: 10.1503/cjs.014318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Acute lung contusion from blunt chest trauma (BCT) is characterized by an intense inflammatory response in the pulmonary parenchyma, which is associated with acute lung injury (ALI), acute respiratory distress syndrome and ventilator-associated pneumonia. We hypothesized that aerosolized indomethacin may reduce pulmonary inflammation and ALI in a rat model of BCT. Methods Sprague-Dawley rats were anesthetized and received a tracheotomy for administration of aerosolized medication through a catheter. The BCT procedure involved free-dropping a hollow metal weight (200 g) from a height of 25.5, 38.3 or 51.2 cm onto the right thorax. We administered 1 mg/kg of indomethacin or 1 mL/kg of saline intratracheally 15 minutes after BCT. The sham group had a similar procedure without the exposure to BCT and treatment. Three hours postimpact, we obtained arterial blood gas and analyzed bronchoalveolar lavage for protein concentration, polymorphonuclear leukocytes (PMN) and cytokine levels, and lung tissue samples were taken for histopathological analysis. Results The rats’ mean arterial pressure and heart rate dropped immediately postimpact but recovered close to that of the sham group after 30 minutes in both control and treatment groups. Compared to BCT alone, indomethacin significantly reduced the total protein level in the lungs (1.06 ± 0.39 mg/mL v. 3.75 ± 1.95 mg/mL, p = 0.006) and alveolar FD-70 leak (0.23 ± 0.19 μg/mL v. 0.53 ± 0.19 μg/mL, p = 0.02). Indomethacin also significantly attenuated the acute inflammatory response in percent PMN (13.33 ±7.5% v. 28.0 ± 12.96%, p = 0.04). Tumour necrosis factor-α and interleukin-6 decreased in the indomethacin group, but the decreases were not significant compared with other groups. Conclusion Aerosolized indomethacin has a protective effect against alveloar tissue permeability and inflammatory response induced by BCT.
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Affiliation(s)
- Raymond L. Kao
- From the Department of National Defense, Royal Canadian Medical Services, Ottawa, Ont. (Kao); Critical Care Western, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Kao, Martin, Rui); and the Centre for Critical Illness Research, Lawson Health Research Institute, London, Ont. (Kao, Martin, Rui)
| | - Weixiong Huang
- From the Department of National Defense, Royal Canadian Medical Services, Ottawa, Ont. (Kao); Critical Care Western, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Kao, Martin, Rui); and the Centre for Critical Illness Research, Lawson Health Research Institute, London, Ont. (Kao, Martin, Rui)
| | - Claudio M. Martin
- From the Department of National Defense, Royal Canadian Medical Services, Ottawa, Ont. (Kao); Critical Care Western, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Kao, Martin, Rui); and the Centre for Critical Illness Research, Lawson Health Research Institute, London, Ont. (Kao, Martin, Rui)
| | - Tao Rui
- From the Department of National Defense, Royal Canadian Medical Services, Ottawa, Ont. (Kao); Critical Care Western, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Kao, Martin, Rui); and the Centre for Critical Illness Research, Lawson Health Research Institute, London, Ont. (Kao, Martin, Rui)
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9
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Güsgen C, Franke A, Hentsch S, Kollig E, Schwab R. [Terrorist attack trauma - an individual entity of polytrauma : A 10-year update]. Chirurg 2019; 88:821-829. [PMID: 28831517 DOI: 10.1007/s00104-017-0488-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The incidence of terrorist attacks is increasing worldwide, and they have also become a permanent threat in European cities. Due to its complexity, terrorist attack trauma places high demands on the strategy of surgical treatment. The combination of various mechanisms, explosions and gunshot injuries, with the characteristic pressure (blast) damage and a high proportion of penetrating trauma with simultaneous burns are characteristic features. Unlike in military conflicts, injuries to people of all ages and without ballistic body protection (body armor) are to be expected. The mechanism of the attack and its local conditions are of relevance for the assessment of the situation and the expected injury patterns. Thus, suicide attacks result in several times higher numbers of fatalities and casualties. Explosions on free ground lead to different types of injury than those in closed or semi-enclosed spaces. The treatment principles of the Advanced Trauma Life Support (ATLS®) are based on the intrahospital care of casualties as well as damage control strategies with trigger factors. In order to prepare and educate clinics and surgeons in Germany for such scenarios, various course formats of the professional societies, the German Society for General and Visceral Surgery (DGAV) and the German Society for Trauma Surgery (DGU) have now been established.
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Affiliation(s)
- C Güsgen
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstr.170, 56072, Koblenz, Deutschland.
| | - A Franke
- Klinik für Unfallchirurgie und Orthopädie, Plastische und Wiederherstellungschirurgie, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
| | - S Hentsch
- Klinik für Unfallchirurgie und Orthopädie, Plastische und Wiederherstellungschirurgie, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
| | - E Kollig
- Klinik für Unfallchirurgie und Orthopädie, Plastische und Wiederherstellungschirurgie, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
| | - R Schwab
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Rübenacherstr.170, 56072, Koblenz, Deutschland
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10
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Affiliation(s)
- Olivier Ranunkel
- Department of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
| | - Firat Güder
- Department of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
| | - Hari Arora
- College of Engineering, Swansea University, Swansea SA1 8EN, United Kingdom
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11
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Yang C, Dong-Hai Z, Ling-Ying L, Yong-Hui Y, Yang W, Li-Wei Z, Rui-Guo H, Jia-Ke C. Simulation of blast lung injury induced by shock waves of five distances based on finite element modeling of a three-dimensional rat. Sci Rep 2019; 9:3440. [PMID: 30837628 PMCID: PMC6401050 DOI: 10.1038/s41598-019-40176-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 02/06/2019] [Indexed: 11/20/2022] Open
Abstract
Blast lung injury (BLI) caused by both military and civilian explosions has become the main cause of death for blast injury patients. By building three-dimensional (3D) models of rat explosion regions, we simulated the surface pressure of the skin and lung. The pressure distributions were performed at 5 distances from the detonation center to the center of the rat. When the distances were 40 cm, 50 cm, 60 cm, 70 cm and 80 cm, the maximum pressure of the body surface were 634.77kPa, 362.46kPa, 248.11kPa, 182.13kPa and 109.29kPa and the surfaces lung pressure ranges were 928–2916 Pa, 733–2254 Pa, 488–1236 Pa, 357–1189 Pa and 314–992 Pa. After setting 6 virtual points placed on the surface of each lung lobe model, simulated pressure measurement and corresponding pathological autopsies were then conducted to validate the accuracy of the modeling. For the both sides of the lung, when the distance were 40 cm, 50 cm and 60 cm, the Pearson’s values showed strong correlations. When the distances were 70 cm and 80 cm, the Pearson’s values showed weak linear correlations. This computational simulation provided dynamic anatomy as well as functional and biomechanical information.
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Affiliation(s)
- Chang Yang
- Department of Burn and Plastic Surgery, Burns Institute, Burn & Plastic Hospital of PLA General Hospital, Fourth Medical Center of PLA General Hospital, Beijing, 100048, PR China
| | - Zhang Dong-Hai
- Department of Burn and Plastic Surgery, Burns Institute, Burn & Plastic Hospital of PLA General Hospital, Fourth Medical Center of PLA General Hospital, Beijing, 100048, PR China
| | - Liu Ling-Ying
- Department of Burn and Plastic Surgery, Burns Institute, Burn & Plastic Hospital of PLA General Hospital, Fourth Medical Center of PLA General Hospital, Beijing, 100048, PR China
| | - Yu Yong-Hui
- Department of Burn and Plastic Surgery, Burns Institute, Burn & Plastic Hospital of PLA General Hospital, Fourth Medical Center of PLA General Hospital, Beijing, 100048, PR China
| | - Wu Yang
- Science and Technology on Transient Impact Laboratory, Beijing, 102202, PR China
| | - Zang Li-Wei
- Science and Technology on Transient Impact Laboratory, Beijing, 102202, PR China
| | - Han Rui-Guo
- Science and Technology on Transient Impact Laboratory, Beijing, 102202, PR China
| | - Chai Jia-Ke
- Department of Burn and Plastic Surgery, Burns Institute, Burn & Plastic Hospital of PLA General Hospital, Fourth Medical Center of PLA General Hospital, Beijing, 100048, PR China.
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12
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Abstract
Thoracic damage control surgery (TDCS) is a decision making tool and derivate of the damage control concept (DCC), where physiological stabilization has a priority over anatomical reconstruction under the pressure of time. Intrathoracic haemorrhage control and pleural decompression are the two main immediate tasks of TDCS, while definitive procedures follow when the patient is stabilised in 24-48 hours. The focus of the thoracic surgeon is on the prevention of the haemorrhage induced coagulopathy, metabolic acidosis and hypothermy formed triad of death. Surgical haemorrhage control and pleural space decompression are to be performed. The individual patients benefit from TDCS procedures whose condition is too severe for a complex immediate reconstruction (polytrauma). Life threatening chest injuries in multiple/mass casualty scenarios in civilian and military environment alike are triaged and treated accordingly. Onset of acute mismatch between the resources (available hands, OP theaters, resources, hardware) and the needs (number and severity of chest trauma cases), a mindset shift should take place, where time and space the two main limiting factors. Airway obstruction, tension haemo/pneumothorax falls into the preventable death category. Chest drainage and emergency thoracotomy are the two main procedures offered by TDCS. An intervention structured organ/injury specific list of procedures is detailed. This is a mix of emergency surgery and cardiothoracic surgery, where less is more. TDSC is not the Holy Grail found to solve all complex thoracic trauma cases, but is a good tool to increase the chance for survival in challenging, and frequently quite hopeless situations.
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Affiliation(s)
- Tamas F Molnar
- Department of Operational Medicine, Medical Humanities Unit, University of Pécs, Pécs, Hungary.,Department Surgery, St Sebastian Thoracic Surgery Unit, Petz A University Teaching Hospital, Győr, Hungary
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13
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Jahangiri K, Ghodsi H, Khodadadizadeh A, Yousef Nezhad S. Pattern and nature of Neyshabur train explosion blast injuries. World J Emerg Surg 2018; 13:3. [PMID: 29387143 PMCID: PMC5775571 DOI: 10.1186/s13017-018-0164-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/11/2018] [Indexed: 11/10/2022] Open
Abstract
Background Explosions are classified as both man-made and complex accidents. Explosive events can cause serious damage to people, property, and the environment. This study aimed to investigate the pattern and nature of damage incurred to the victims of the Neyshabur Train Explosion. Methods The current study is a descriptive cross-sectional study that was retrospectively performed on 99 individuals using census method and documents victims hospitalized due to the Neyshabur train disaster (February 2004) in 2016. In this study, different variables such as age, sex, type of injury, treatment, etc. were examined using a questionnaire and were analyzed using SPSS16. Results The results showed that 50.5% of victims were males with mean age of 30.33 ± 4.27 years and most of them were in 20- to 40-year age group. A total of 98 victims were discharged after treatment, and 1 victim died due to the severity of injuries after 3 days of hospitalization. Second type of injuries caused by the explosion accounted for most of the injuries (55.6%), and most treatments (54.5%) were related to the specific field of orthopedics. Conclusion Handling and transportation of fuels and chemicals via rail transport system is one of the potential hazards that threatens human life. The results showed that the highest numbers of victims were in 20- to 40-year age group, which is the age of economic efficiency. The prevention and reduction of human and financial losses resulting from accidents require proper national planning.
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Affiliation(s)
- Katayoun Jahangiri
- Department of Health in Disasters and Emergencies, School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hasan Ghodsi
- Department of Health in Disasters and Emergencies, School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Khodadadizadeh
- Department of Health in Disasters and Emergencies, School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sadegh Yousef Nezhad
- Department of Health in Disasters and Emergencies, School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sreekanth C, Bai R. Blast Lung Injury: Our Experience. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791702400206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Blast lung injury (BLI) is a relatively uncommon feature of victims involved in bomb blasts. Patients may present with clinical features of different proportions; and clinical imaging forms an important tool in managing these patients. BLI is very uncommon and therefore offers a challenge to the emergency room personnel. A complete patient assessment with a holistic approach should be kept in mind. We present a case of suspected lung injury of a young female who was an innocent victim of BLI and who was managed conservatively.
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Affiliation(s)
| | - R Bai
- Emergency and Critical Care Services, Department of Accident, Emergency and Critical Care Services, MS Ramaiah Medical College, Bangalore-560054, Karnataka, India
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15
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Abstract
Exposure to blast events can cause severe trauma to vital organs such as the lungs, ears, and brain. Understanding the mechanisms behind such blast-induced injuries is of great importance considering the recent trend towards the use of explosives in modern warfare and terrorist-related incidents. To fully understand blast-induced injury, we must first be able to replicate such blast events in a controlled environment using a reproducible method. In this technique using shock tube equipment, shock waves at a range of pressures can be propagated over live cells grown in 2D, and markers of cell viability can be immediately analyzed using a redox indicator assay and the fluorescent imaging of live and dead cells. This method demonstrated that increasing the peak blast overpressure to 127 kPa can stimulate a significant drop in cell viability when compared to untreated controls. Test samples are not limited to adherent cells, but can include cell suspensions, whole-body and tissue samples, through minor modifications to the shock tube setup. Replicating the exact conditions that tissues and cells experience when exposed to a genuine blast event is difficult. Techniques such as the one presented in this article can help to define damage thresholds and identify the transcriptional and epigenetic changes within cells that arise from shock wave exposure.
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Affiliation(s)
- Niall J Logan
- Department of Bioengineering, Imperial College London
| | - Hari Arora
- Department of Bioengineering, Imperial College London
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16
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Singh AK, Ditkofsky NG, York JD, Abujudeh HH, Avery LA, Brunner JF, Sodickson AD, Lev MH. Blast Injuries: From Improvised Explosive Device Blasts to the Boston Marathon Bombing. Radiographics 2016; 36:295-307. [PMID: 26761543 DOI: 10.1148/rg.2016150114] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although most trauma centers have experience with the imaging and management of gunshot wounds, in most regions blast wounds such as the ones encountered in terrorist attacks with the use of improvised explosive devices (IEDs) are infrequently encountered outside the battlefield. As global terrorism becomes a greater concern, it is important that radiologists, particularly those working in urban trauma centers, be aware of the mechanisms of injury and the spectrum of primary, secondary, tertiary, and quaternary blast injury patterns. Primary blast injuries are caused by barotrauma from the initial increased pressure of the explosive detonation and the rarefaction of the atmosphere immediately afterward. Secondary blast injuries are caused by debris carried by the blast wind and most often result in penetrating trauma from small shrapnel. Tertiary blast injuries are caused by the physical displacement of the victim and the wide variety of blunt or penetrating trauma sustained as a result of the patient impacting immovable objects such as surrounding cars, walls, or fences. Quaternary blast injuries include all other injuries, such as burns, crush injuries, and inhalational injuries. Radiography is considered the initial imaging modality for assessment of shrapnel and fractures. Computed tomography is the optimal test to assess penetrating chest, abdominal, and head trauma. The mechanism of blast injuries and the imaging experience of the victims of the Boston Marathon bombing are detailed, as well as musculoskeletal, neurologic, gastrointestinal, and pulmonary injury patterns from blast injuries.
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Affiliation(s)
- Ajay K Singh
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND-210, Boston, MA 02114 (A.K.S., H.H.A., L.A.A., M.H.L.); Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (N.G.D.); Department of Radiology, Naval Medical Center, Portsmouth, Va (J.D.Y.); Department of Radiology, University of Southern California, Los Angeles, Calif (J.F.B.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.D.S.)
| | - Noah G Ditkofsky
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND-210, Boston, MA 02114 (A.K.S., H.H.A., L.A.A., M.H.L.); Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (N.G.D.); Department of Radiology, Naval Medical Center, Portsmouth, Va (J.D.Y.); Department of Radiology, University of Southern California, Los Angeles, Calif (J.F.B.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.D.S.)
| | - John D York
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND-210, Boston, MA 02114 (A.K.S., H.H.A., L.A.A., M.H.L.); Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (N.G.D.); Department of Radiology, Naval Medical Center, Portsmouth, Va (J.D.Y.); Department of Radiology, University of Southern California, Los Angeles, Calif (J.F.B.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.D.S.)
| | - Hani H Abujudeh
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND-210, Boston, MA 02114 (A.K.S., H.H.A., L.A.A., M.H.L.); Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (N.G.D.); Department of Radiology, Naval Medical Center, Portsmouth, Va (J.D.Y.); Department of Radiology, University of Southern California, Los Angeles, Calif (J.F.B.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.D.S.)
| | - Laura A Avery
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND-210, Boston, MA 02114 (A.K.S., H.H.A., L.A.A., M.H.L.); Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (N.G.D.); Department of Radiology, Naval Medical Center, Portsmouth, Va (J.D.Y.); Department of Radiology, University of Southern California, Los Angeles, Calif (J.F.B.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.D.S.)
| | - John F Brunner
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND-210, Boston, MA 02114 (A.K.S., H.H.A., L.A.A., M.H.L.); Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (N.G.D.); Department of Radiology, Naval Medical Center, Portsmouth, Va (J.D.Y.); Department of Radiology, University of Southern California, Los Angeles, Calif (J.F.B.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.D.S.)
| | - Aaron D Sodickson
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND-210, Boston, MA 02114 (A.K.S., H.H.A., L.A.A., M.H.L.); Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (N.G.D.); Department of Radiology, Naval Medical Center, Portsmouth, Va (J.D.Y.); Department of Radiology, University of Southern California, Los Angeles, Calif (J.F.B.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.D.S.)
| | - Michael H Lev
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, FND-210, Boston, MA 02114 (A.K.S., H.H.A., L.A.A., M.H.L.); Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (N.G.D.); Department of Radiology, Naval Medical Center, Portsmouth, Va (J.D.Y.); Department of Radiology, University of Southern California, Los Angeles, Calif (J.F.B.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.D.S.)
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Pavlidis P, Karakasi V. A Retrospective Demographic and Clinicopathologic Review of Deaths Resulting from Minefield Explosions During Migrants’ Attempts to Enter Greece from Turkey Between 1997 and 2008. J Forensic Sci 2016; 61:656-60. [DOI: 10.1111/1556-4029.13052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 07/27/2015] [Accepted: 08/15/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Pavlos Pavlidis
- Laboratory of Forensic Sciences; School of Medicine; Democritus University of Thrace; Alexandroupolis GR 68100 Greece
| | - Valeria Karakasi
- Laboratory of Forensic Sciences; School of Medicine; Democritus University of Thrace; Alexandroupolis GR 68100 Greece
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18
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Abstract
Pulmonary injuries are a major source of morbidity and mortality associated with trauma. Trauma includes injuries associated with accidents and falls as well as blast injuries caused by explosives. The prevalence and mortality of these injuries has made research of pulmonary injury a major priority. Lungs have a complex structure, with multiple types of tissues necessary to allow successful respiration. The soft, porous parenchyma is the component of the lung which contains the alveoli responsible for gas exchange. Parenchyma is also the portion which is most susceptible to traumatic injury. Finite element simulations are an important tool for studying traumatic injury to the human body. These simulations rely on material properties to accurately recreate real world mechanical behaviors. Previous studies have explored the mechanical properties of lung tissues, specifically parenchyma. These studies have assumed material isotropy but, to our knowledge, no study has thoroughly tested and quantified this assumption. This study presents a novel methodology for assessing isotropy in a tissue, and applies these methods to porcine lung parenchyma. Briefly, lung parenchyma samples were dissected so as to be aligned with one of the three anatomical planes, sagittal, frontal, and transverse, and then subjected to compressive mechanical testing. Stress-strain curves from these tests were statistically compared by a novel method for differences in stresses and strains at percentages of the curve. Histological samples aligned with the anatomical planes were also examined by qualitative and quantitative methods to determine any differences in the microstructural morphology. Our study showed significant evidence to support the hypothesis that lung parenchyma behaves isotropically.
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19
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Skotak M, Wang F, Alai A, Holmberg A, Harris S, Switzer RC, Chandra N. Rat injury model under controlled field-relevant primary blast conditions: acute response to a wide range of peak overpressures. J Neurotrauma 2013; 30:1147-60. [PMID: 23362798 DOI: 10.1089/neu.2012.2652] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We evaluated the acute (up to 24 h) pathophysiological response to primary blast using a rat model and helium driven shock tube. The shock tube generates animal loadings with controlled pure primary blast parameters over a wide range and field-relevant conditions. We studied the biomechanical loading with a set of pressure gauges mounted on the surface of the nose, in the cranial space, and in the thoracic cavity of cadaver rats. Anesthetized rats were exposed to a single blast at precisely controlled five peak overpressures over a wide range (130, 190, 230, 250, and 290 kPa). We observed 0% mortality rates in 130 and 230 kPa groups, and 30%, 24%, and 100% mortality rates in 190, 250, and 290 kPa groups, respectively. The body weight loss was statistically significant in 190 and 250 kPa groups 24 h after exposure. The data analysis showed the magnitude of peak-to-peak amplitude of intracranial pressure (ICP) fluctuations correlates well with mortality rates. The ICP oscillations recorded for 190, 250, and 290 kPa are characterized by higher frequency (10-20 kHz) than in other two groups (7-8 kHz). We noted acute bradycardia and lung hemorrhage in all groups of rats subjected to the blast. We established the onset of both corresponds to 110 kPa peak overpressure. The immunostaining against immunoglobulin G (IgG) of brain sections of rats sacrificed 24-h post-exposure indicated the diffuse blood-brain barrier breakdown in the brain parenchyma. At high blast intensities (peak overpressure of 190 kPa or more), the IgG uptake by neurons was evident, but there was no evidence of neurodegeneration after 24 h post-exposure, as indicated by cupric silver staining. We observed that the acute response as well as mortality is a non-linear function over the peak overpressure and impulse ranges explored in this work.
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Affiliation(s)
- Maciej Skotak
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Nebraska, USA
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20
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Abstract
A large family home exploded after a propane leak ignited. Initial reports from the scene noted that 11 people were injured, with many sustaining critical injuries. Immediately, multiple helicopter emergency medical services aircraft were dispatched to respond to the scene, and ground emergency medical services (EMS) providers were en route. Of the five aircraft requested, only two were available to respond; one aircraft was out for maintenance, and two others were committed to other missions.
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21
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Abstract
Blast injuries have been increasing in the civilian setting and clinicians need to understand the spectrum of injury and management strategies. Multisystem trauma associated with combined blunt and penetrating injuries is the rule. Explosions in closed spaces increase the likelihood of primary blast injury. Rupture of tympanic membranes is an inaccurate marker for severe primary blast injury. Blast lung injury manifests early and should be managed with lung-protective ventilation. Blast brain injury is more common than previously appreciated.
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Affiliation(s)
- Daniel Dante Yeh
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, 165 Cambridge St. #810, Boston, MA, 02114, USA.
| | - William P Schecter
- Division of Surgery, San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, San Francisco, CA, 94143, USA
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22
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Abstract
There are many similarities between health issues affecting military and civilian patient populations, with the exception of the relatively small but vital segment of active soldiers who experience high-energy blast injuries during combat. A rising incidence of major injuries from explosive devices in recent campaigns has further complicated treatment and recovery, highlighting the need for tissue regenerative options and intensifying interest in the possible role of stem cells for military medicine. In this review we outline the array of tissue-specific injuries typically seen in modern combat - as well as address a few complications unique to soldiers - and discuss the state of current stem cell research in addressing each area. Embryonic, induced-pluripotent and adult stem cell sources are defined, along with advantages and disadvantages unique to each cell type. More detailed stem cell sources are described in the context of each tissue of interest, including neural, cardiopulmonary, musculoskeletal and sensory tissues, with brief discussion of their potential role in regenerative medicine moving forward. Additional commentary is given to military stem cell applications aside from regenerative medicine, such as blood pharming, immunomodulation and drug screening, with an overview of stem cell banking and the unique opportunity provided by the military and civilian overlap of stem cell research.
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Affiliation(s)
- Gregory T Christopherson
- The National Institutes of Health, The National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD 20892, USA
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23
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Burgess P, E Sullivent E, M Sasser S, M Wald M, Ossmann E, Kapil V. Managing traumatic brain injury secondary to explosions. J Emerg Trauma Shock 2011; 3:164-72. [PMID: 20606794 PMCID: PMC2884448 DOI: 10.4103/0974-2700.62120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 01/08/2010] [Indexed: 11/06/2022] Open
Abstract
Explosions and bombings are the most common deliberate cause of disasters with large numbers of casualties. Despite this fact, disaster medical response training has traditionally focused on the management of injuries following natural disasters and terrorist attacks with biological, chemical, and nuclear agents. The following article is a clinical primer for physicians regarding traumatic brain injury (TBI) caused by explosions and bombings. The history, physics, and treatment of TBI are outlined.
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Affiliation(s)
- Paula Burgess
- National Center for Environmental Health, Centers for Disease Control and Prevention, USA
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24
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Advancing critical care: joint combat casualty research team and joint theater trauma system. AACN Adv Crit Care 2011; 21:260-76; quiz 278. [PMID: 20683227 DOI: 10.1097/nci.0b013e3181e67385] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Despite the severity and complexity of injuries, survival rates among combat casualties are equal to or better than those from civilian trauma. This article summarizes the evidence regarding innovations from the battlefield that contribute to these extraordinary survival rates, including preventing hemorrhage with the use of tourniquets and hemostatic dressings, damage control resuscitation, and the rapid evacuation of casualties via MEDEVAC and the US Air Force Critical Care Air Transport Teams. Care in the air for critically injured casualties with pulmonary injuries and traumatic brain injury is discussed to demonstrate the unique considerations required to ensure safe en route care. Innovations being studied to decrease sequelae associated with complex orthopedic and extremity trauma are also presented. The role and contributions of the Joint Combat Casualty Research Team and the Joint Theater Trauma System are also discussed.
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25
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Abstract
Terrorist bombings continue to remain a risk for local jurisdictions, and retrospective data from the United States show that bombings occur in residential and business areas due to interpersonal violence without political motives. In the event of a mass-casualty bombing incident, prehospital care providers will have the responsibility for identifying and managing blast injuries unique to bombing victims. In a large-scale event, emergency medical services personnel should be required to provide prolonged medical care in the prehospital setting, and they will be able to deliver improved care with a better understanding of blast injuries and a concise algorithm for managing them. Blast injuries are categorized as primary, secondary, tertiary, and quaternary, and these injuries are related to the mechanism of injury from the blast event. After an initial evaluation, the emergency healthcare provider should consider following a universal algorithm to identify and treat blast injuries within these categories to prevent further morbidity or mortality in the prehospital setting.
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27
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Abstract
The ear by design is exquisitely sensitive to barotrauma. As a result, it is typically the first organ affected in primary blast injury. The most common symptoms encountered include hearing loss, ringing, and drainage. In severe cases, the highest priority is appropriately directed toward diagnosis and treatment of life-threatening injuries; however, injury to the ear is missed frequently. With simple screening procedures, limited management, and appropriate otolaryngologic referral, acute and long-term morbidity can be averted for both critical and noncritical patients. The article provides an overview of blast mechanics and pathophysiology. It details various blast-related injuries to the external, middle, and inner ear. Standard of care assessment and management strategies are presented for acute and late otologic sequelae of the blast-injured patient.
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Affiliation(s)
- D Spencer Darley
- Department of Otolaryngologyand Communication Science, SUNY Upstate Medical University, NY, USA
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28
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Blast injuries from bombings: what craniofacial and maxillofacial surgeons need to know. J Craniofac Surg 2010; 21:954-9. [PMID: 20647833 DOI: 10.1097/scs.0b013e3181e17b79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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29
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Zhou H, Ma G. Stress amplification effect of lung. Med Hypotheses 2009; 74:37-8. [PMID: 19747779 DOI: 10.1016/j.mehy.2009.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2009] [Accepted: 08/08/2009] [Indexed: 10/20/2022]
Abstract
Under a blast or impact load, rapid movement of the thoracic wall generates stress in lung, a foam-like structure of high compressibility, which is different from general solids. Due to this unique characteristic, it is hypothesized that when lung is subjected to a blast or impact load, there will be an initial low stress progressively developed into a high stress in a short duration in a thin layer of parenchyma at the lung surface. Compared to the incident stress, the actual stress value experienced by lung is amplified, which may cause alveolar-capillary walls to burst, subsequently results in injuries such as edema or hemorrhage. This hypothesis can explain one significant phenomenon observed in animal tests that the gross thoracic compression do not cause major lung injury and there is a close relationship between thoracic wall velocity and the lung injury degree. According to the hypothesis, under a blast or impact load, there should be a significant injury degree discrepancy between a thin layer of parenchyma at the lung surface and the rest of the lung. Serious injuries should be mainly found in this thin layer, which can be employed to test whether this amplified effect exists or not. The hypothesis may shed some light on the mechanism of blast lung injury.
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Affiliation(s)
- Hongyuan Zhou
- Protective Technology Research Center, Nanyang Technological University, 50 Nanyang Avenue, 639798 Singapore, Singapore
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30
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Abstract
Health-care providers are increasingly faced with the possibility of needing to care for people injured in explosions, but can often, however, feel undertrained for the unique aspects of the patient's presentation and management. Although most blast-related injuries (eg, fragmentation injuries from improvised explosive devices and standard military explosives) can be managed in a similar manner to typical penetrating or blunt traumatic injuries, injuries caused by the blast pressure wave itself cannot. The blast pressure wave exerts forces mainly at air-tissue interfaces within the body, and the pulmonary, gastrointestinal, and auditory systems are at greatest risk. Arterial air emboli arising from severe pulmonary injury can cause ischaemic complications-especially in the brain, heart, and intestinal tract. Attributable, in part, to the scene chaos that undoubtedly exists, poor triage and missed diagnosis of blast injuries are substantial concerns because injuries can be subtle or their presentation can be delayed. Management of these injuries can be a challenge, compounded by potentially conflicting treatment goals. This Seminar aims to provide a thorough overview of these unique primary blast injuries and their management.
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Affiliation(s)
- Stephen J Wolf
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO 80204, USA.
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Abstract
OBJECTIVE To improve identification of traumatic brain injury (TBI) in survivors of nonmilitary bomb blasts during the acute care phase. METHODS The Centers for Disease Control and Prevention convened a meeting of experts in TBI, emergency medicine, and disaster response to review the recent literature and make recommendations. RESULTS Seven key recommendations were proposed: (1) increase TBI awareness among medical professionals; (2) encourage use of standard definitions and consistent terminology; (3) improve screening methods for TBI in the acute care setting; (4) clarify the distinction between TBI and acute stress disorder; (5) encourage routine screening of hospitalized trauma patients for TBI; (6) improve identification of nonhospitalized TBI patients; and (7) integrate the appropriate level of TBI identification into all-hazards mass casualty preparedness. CONCLUSIONS By adopting these recommendations, the United States could be better prepared to identify and respond to TBI following future bombing events.
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Abstract
Bomb attacks on the civilian population are one of the primary instruments of global terrorism. Confronted as we are with the increasingly real threat in Europe too, we now have to be constantly prepared for the mass casualties and new injury patterns in trauma care that are caused by terrorist bombings. This is extraordinarily challenging, on both medical and logistical levels, for the hospitals involved. In this review the basic mechanisms of blast injuries are clarified. In addition, the fundamental principles of triage and the management of multiple trauma are presented; these are oriented on ATLS (advanced trauma life support) and DCS (damage control surgery) guidelines. These treatment concepts, which have proved their worth in both military and civilian environments, involve ongoing triage and constant situational assessment and are the basis of improved treatment results in the care of multiply traumatized victims of terrorist bombings.
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Affiliation(s)
- R Schwab
- Abteilung für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus , Rübenacherstr. 170, 56072 Koblenz, Deutschland.
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Emergency and Rescue Structures in Germany: Structures, Challenges, and Mathematical Considerations Concerning the Preparedness for Mass-Gathering Events. Prehosp Disaster Med 2005. [DOI: 10.1017/s1049023x00014333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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