Primary Pulmonary Blast Injury



The blast effects of explosions cause a wide spectrum of injury patterns which today’s physicians must be equipped to recognize and treat. Before the Oklahoma attack, virtually al of the up to 4000 explosions that occurred in US homes and workplaces each year were “low intensity” devices. However, as we move further into the 21st century, we are beginning to see increasing numbers of large explosions and the mass casualty situations that they create. Industrial accidents, military combat, the threat of nuclear war, and terrorist bombings are four major foci of concern. With the recent surge of terrorist attacks on American soil (the 1995 bombing of the Murrah Federal Building in Oklahoma City, and the 2001 commercial airliner attacks on both World Trade Centers in New York City and the Pentagon Building in Washington DC), civilian physicians and hospitals must carefully triage large numbers of patients in efforts to provide effective care, yet strive to prevent hospitals from becoming overwhelmed with unnecessary admissions. Much of the early literature on blast injury was generated by the US military in an effort to predict the severity of injury from an explosion and to better understand how to provide optimal medical care to soldiers at war. We now must apply our understanding of this knowledge to the civilian population. Understanding the mechanics of explosions, the pathophysiology of blast injury, the radiographic and clinical presentation of blast injuries, and the management of pulmonary blast injury will be the focus of this chapter.


Blast Wave Positive Pressure Ventilation World Trade Center Blast Injury Pulmonary Contusion 
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.

Selected References

  1. Karmy-Jones R, Kissinger D, Champion HR, Golockovsky M: Bomb related injuries. Mil Med. 159:536, 1994.PubMedGoogle Scholar
  2. Leibovich D, Grofit ON, Stein M, et al. Blast injuries: bus vs open-air bombings-a comparative study of injuries in survivors of open-air vs confined-space explosions. J Trauma. 1996; 41:1030–1035.CrossRefGoogle Scholar
  3. Hirsch M, Bazini J. Blast injury of the chest. Clin Radiol. 1969; 20: 362–370.PubMedCrossRefGoogle Scholar
  4. Ho AM, Ling E. Systemic air embolism after lung trauma. Anesthesiology. 1999; 90(2): 564–575.PubMedCrossRefGoogle Scholar
  5. Huller T, Bazini Y. Blast injuries of the chest and abdomen. Arch Surg. 1970; 100:24–30PubMedCrossRefGoogle Scholar
  6. Goldfarb B, Bahnson HT. Early and late effects on the heart of small amounts of air in the coronary circulation. J Thorac Surg. 1980; 80: 708–17.Google Scholar
  7. Meyer, R. Explosives. New York: VCH Publishers. 1987. Meyer, R. Explosives. New York: VCH Publishers. 1987.Google Scholar
  8. Phillips YY. Primary blast injuries. Ann Emerg Med. 1986; 15: 1445–1450.CrossRefGoogle Scholar
  9. Phillips YY, Richmond DR. Primary blast injury and basic research: a brief history. In: Bellamy RF, Zajtchuk R, eds. Conventional Warfare: Ballistic, Blast, and Burn Injuries. Washington, DC: Office of the Surgeon General of the US Army; 1991: 221–240.Google Scholar
  10. Pizov R, Arieh O-E, Matot I, Weiss YG, Eidelman LA, Rivkind AI, Sprung CL. Blast lung injury from an explosion on a civilian bus. Chest. 1999; 115: 165–172.PubMedCrossRefGoogle Scholar
  11. Sorkine P, Szold O, Kluger Y, et at. Permissive hypercapnea ventilation in patients with severe pulmonary blast injury. J Trauma. 1998; 17: 555–575.Google Scholar
  12. Saada M, Goarin J-P, Riou B, Rouly JJ, Jacques Y, Guesde R, Viars P. Systemic gas embolism complicating pulmonary contusion-Diagnosis and management using transesophageal echocardiography. Am J Respir Crit Care Med. 1995; 152: 812–815.PubMedGoogle Scholar
  13. Stuhmiller JH, Phillips YY, Richard DR. The physics and mechanisms of primary blast injury. In: Bellamy RF, Zajtchuk R, eds. Conventional Warfare: Ballistic, Blast, and Burn Injuries. Washington DC: Office of the Surgeon General of the US Army; 1991: 241–270.Google Scholar
  14. Wightman JM, Gladish SL. State of the art: explosions and blast injuries. Ann Emerg Med. 2001; 37(6): 664–78.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

There are no affiliations available

Personalised recommendations