Pathobiology of Blast Injury

  • A. M. Dennis
  • P. M. Kochanek


Injury due to explosive detonation has previously been isolated to industrial accidents and soldiers and civilians in areas of armed military action. Substantial data regarding blast-related patterns of injury has come from military reports and research, and there have been significant advances in protective vehicle and body armor, ‘far forward’ provision of medical care, and evacuation procedures. Despite this, explosive munitions and improvised explosive devices still comprise the majority of combat morbidity and mortality [1]–[4]. There is also increased targeting of civilians in a global political environment where incendiary devices are a principle instrument of modern terrorism [5]–[7]. Events in preceding decades indicate a critical need for both civilian and military emergency and intensive care providers to understand the pathophysiology and management of blast-related injuries.


Traumatic Brain Injury Hemorrhagic Shock Blast Wave Therapeutic Hypothermia Severe Traumatic Brain Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Cernak I, Savic J, Ignjatovic D, Jevtic M (1999) Blast injury from explosive munitions. J Trauma 47:96–104PubMedGoogle Scholar
  2. 2.
    Okie S (2005) Traumatic brain injury in the war zone. N Engl J Med 352:2043–2047PubMedCrossRefGoogle Scholar
  3. 3.
    Zouris JM, Walker GJ, Dye J, Galarneau M (2006) Wounding patterns for US marines and sailors during operation Iraqi freedom, Major Combat Phase. Mil Med 171:246–252PubMedGoogle Scholar
  4. 4.
    Gondusky JS, Reiter MP (2005) Protecting military convoys in Iraq. Mil Med 170:546–549PubMedGoogle Scholar
  5. 5.
    Kluger Y, Peleg K, Daniel-Aharonson L, The Israeli Trauma Group (2004) The special injury pattern in terrorist bombings. J Am Coll Surg 199:875–879PubMedCrossRefGoogle Scholar
  6. 6.
    Peleg K, Aharonson-Daniel L, Stein M, et al (2004) Gunshot and explosion injuries. Ann Surg 239:311–318PubMedCrossRefGoogle Scholar
  7. 7.
    Hadden WA, Rutherford WH, Merrett JD (1978) The injuries of terrorist bombing: a study of 1532 consecutive patients. Br J Surg 65:525–531PubMedCrossRefGoogle Scholar
  8. 8.
    Born CT (2005) Blast trauma: The fourth weapon of mass destruction. Scan J Surg 94: 279–285Google Scholar
  9. 9.
    Mayorga MA (1997) The pathology of primary blast overpressure injury. Toxicology 121: 17–28PubMedCrossRefGoogle Scholar
  10. 10.
    Elsayed NM (1997) Toxicology of blast overpressure. Toxicology 121:1–15PubMedCrossRefGoogle Scholar
  11. 11.
    Phillips YY (1986) Primary blast injuries. Ann Emerg Med 15:1446–1450PubMedCrossRefGoogle Scholar
  12. 12.
    Phillips YY, Richmond DR (1991) Primary blast injury and basic reasearch. In: Textbook of Military Medicine, part 1, vol 1, Office of the Surgeon General, US Army, pp 221–240Google Scholar
  13. 13.
    Stuhmiller JH, Phillips YY, Richmond DR (1991) The physics and mechanics of primary blast injury. In: Textbook of Military Medicine, part 1, vol 1, Office of the Surgeon General, US Army, pp 241–270Google Scholar
  14. 14.
    Sharpnack DD, Johnson AJ, Phillips YY (1991) The pathology of primary blast injury. In: Textbook of Military Medicine, part 1, vol 1, Office of the Surgeon General, US Army, pp 271–294Google Scholar
  15. 15.
    Guy RJ, Cripps NPJ (2000) Primary blast injury. J R Nav Med Serv 86:27–31PubMedGoogle Scholar
  16. 16.
    Mott FW (1916) The effects of high explosives upon the central nervous system. Lancet 1:331–338Google Scholar
  17. 17.
    Mott FW (1917) The microscopic examination of the brains of two men dead of commotio cerebri (shell shock) without visible external injury. J R Army Med Corps 29:662–677Google Scholar
  18. 18.
    Knudsen SK, Øen EO (2003) Blast-induced neurotrauma in whales. Neurosci Res 46:377–386PubMedCrossRefGoogle Scholar
  19. 19.
    Gennarelli TA, Thibault LE, Adams JH, Graham DI, Thompson CJ, Marcincin RP (1982) Diffuse axonal injury and traumatic coma in the primate. Ann Neurol 12:564–574PubMedCrossRefGoogle Scholar
  20. 20.
    Wood H, Sweetser HB (1940) Punctate cerebral hemorrhage following thoracic Trauma. Nav Med Bull 46:51–56Google Scholar
  21. 21.
    Levi L, Borovich B, Guilburd J, et al (1990) Wartime neurosurgical experience in Lebanon, 1982–85 II. Israel J Med Sci 26:555–578PubMedGoogle Scholar
  22. 22.
    Yuan XQ, Wade CE (1992) Traumatic brain injury attenuates the effectiveness of lactated ringer’s solution resuscitation of hemorrhaginc shock in Rats. Surg Gynecol Obstet 174:305–312PubMedGoogle Scholar
  23. 23.
    Chesnut RM, Gautille T, Blunt BA, Klauber MR, Marshall LF (1998) Neurogenic hypotension in patients with severe head injuries. J Trauma 44:958–963PubMedGoogle Scholar
  24. 24.
    Cernak I, Wang Z, Jiang J, Bian X, Savic J (2001) Ultrastructural and functional characteristics of blast injury-induced neurotrauma. J Trauma 50:695–706PubMedGoogle Scholar
  25. 25.
    Säljö A, Bao F, Haglid KG, Hansson H (2000) Blast exposure causes redistribution of phosphorylated neurofilament subunits in neurons of the adult rat brain. J Neurotrauma 17: 719–726PubMedCrossRefGoogle Scholar
  26. 26.
    Kaur C, Singh J, Lim MK, Ng BL, Yap EPH, Ling EA (1996) Studies of the choroid plexus and its associated epiplexus cells in the lateral ventricles of rats following an exposure to a single non-penetrative blast. Arch Histol Cytol 59:239–248PubMedGoogle Scholar
  27. 27.
    Kaur C, Singh J, Lim MK, Ng BL, Yap EPH, Ling EA (1995) The response of neurons and microglia to blast injury in the rat brain. Neuropath App Neurobio 21:369–377CrossRefGoogle Scholar
  28. 28.
    Bayir H, Kagan VE, Tyurina YY, Tyurin V, Ruppel R, Adelson PD (2002) Assessment of antioxidant reserves and oxidative stress in CSF after severe TBI in infants and children. Ped Res 51:571–578CrossRefGoogle Scholar
  29. 29.
    Saljo A, Bao F, Jingshan S, Hamberger A, Hansson H, Haglid KG (2002) Exposure to short-lasting impulse noise causes c-Jun expression and induction of apoptosis in the adult rat brain. J Neurotrauma 19:985–991PubMedCrossRefGoogle Scholar
  30. 30.
    Saljo A, Bao F, Shi J, Hamberger A, Hansson H, Haglid K (2002) Expression of c-Fos and c-Myc and deposition of B-APP in neurons in the adult rat brain as a result of exposure to short-lasting impulse noise. J Neurotrauma 19:379–385PubMedCrossRefGoogle Scholar
  31. 31.
    Cernak I, Radosevic P, Malicevic Z, Savic J (1995) Experimental magnesium depletion in adult rabbits caused by blast overpressure. Mag Res 8:249–259Google Scholar
  32. 32.
    Chesnut RM, Marshall SB, Piek J, Blunt BA, Klauber MR, Marshall LF (1993) Early and late systemic hypotension as a frequent and fundamental source of cerebral ischemia following severe brain injury in the traumatic coma data bank. Acta Neurochir Suppl 59:121–125Google Scholar
  33. 33.
    Nelson TJ, Wall DB, Stedje-Larsen ET, Clark RT, Chamber LW, Bohman HR (2006) Predictors of mortality in close proximity blast injuries during operation iraqi freedom. J Am Coll Surg 202:418–422PubMedCrossRefGoogle Scholar
  34. 34.
    Irwin RJ, Lerner MR, Bealer JF, Mantor C, Brackett DJ, Tuggle DW (1999) Shock after blast wave injury is caused by a vagally mediated reflex. J Trauma 47:105–110PubMedCrossRefGoogle Scholar
  35. 35.
    Clark RSB, Kochanek PM, Dixon CE, et al (1997) Early neuropathologic effects of mild or moderate hypoxemia after controlled cortical impact injury in rats. J Neurotrauma 14:179–189PubMedGoogle Scholar
  36. 36.
    Elsayed NM, Gorbunov NV, Kagan VE (1997) A Proposed biochemical mechanism involving hemoglobin for blast overpressure-induced injury. Toxicology 121:81–90PubMedCrossRefGoogle Scholar
  37. 37.
    Gowers CJ, Parr MJ (2005) Recombinant activated factor VIIa use in massive transfusion and coagulopathy unresponsive to conventional therapy. Anaesth Intensive Care 33:196–200PubMedGoogle Scholar
  38. 38.
    Holcomb JB, Hoots K, Moore FA (2005) Treatment of an acquired coagulopathy with recombinant activated factor VII in a damage-control patient. Mil Med 170:287–290PubMedGoogle Scholar
  39. 39.
    Bhardwaj A, Ulatowski JA (2004) Hypertonic saline solutions in brain injury. Curr Opin Crit Care 10:126–131PubMedCrossRefGoogle Scholar
  40. 40.
    Holcomb JB (2003) Fluid resuscitation in modern combat casualty care: Lessons learned from Somalia. J Trauma 54:S46–S51PubMedGoogle Scholar
  41. 41.
    Manley GT, Binder DK, Papadopoulos MC, Verkman AS (2004) New insights into water transport and edema in the central nervous system from phenotype analysis of aquaporin-4 null mice. Neuroscience 129:983–991PubMedCrossRefGoogle Scholar
  42. 42.
    Dietrich WD, Alonso O, Busto R, et al (1996) Widespread hemodynamic depression and focal platelet accumulation after fluid percussion brain injury. J Cereb Blood Flow Metab 16:481–489PubMedCrossRefGoogle Scholar
  43. 43.
    Lee KH, Lukovits T, Friedman JA (2006) “Triple-H” therapy for cerebral vasospasm following subarachnoid hemorrhage. Neurocrit Care 4:68–76PubMedCrossRefGoogle Scholar
  44. 44.
    Andresen J, Shaft NI, Bryan RM (2005) Endothelial influences on cerebrovascular tone. J Appl Physiol 100:318–327CrossRefGoogle Scholar
  45. 45.
    The SAFE Study Investigators (2004) A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 350:2247–2256CrossRefGoogle Scholar
  46. 46.
    Scheff SW, Sullivan PG (1999) Cyclosporin A significantly ameliorates cortical damage following experimental traumatic brain injury in rodents. J Neurotrauma 16:783–792PubMedGoogle Scholar
  47. 47.
    Kochanek PM, Jenkins LW, Clark RSB (2005) Traumatic brain injury: laboratory studies. In: Tisherman SA, Sterz F (eds) Therapeutic Hypothermia, Springer Science + Business Media, Inc., New York, pp 63–86CrossRefGoogle Scholar
  48. 48.
    Wu X, Kochanek PM, Cochran K, et al (2005) Mild hypothermia improves survival after prolonged, traumatic hemorrhagic shock in pigs. J Trauma 59:291–299PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media Inc. 2007

Authors and Affiliations

  • A. M. Dennis
    • 1
  • P. M. Kochanek
    • 1
  1. 1.Department of Critical Care MedicineUniversity of PittsburghPittsburghUSA

Personalised recommendations