The pathophysiology of primary blast injury and its implications for treatment. Part I: The thorax

Abstract There is insufficient evidence to support a definitive approach to the clinical management of primary pulmonary blastinjury. Post-blast cardiovascular and pulmonary changes are reviewed in this paper in order to highlight important aspects in the immediate management of the blast injury casualty. Blast profiles and theoretical mechanisms of injury vary widel but all result in mechanical disruption and cause similar pathological, physiological and biochemical responses. Some patients may present acutely, while others appear unharmed and develop respiratory failure 12–24 hours later. Treatment outcome may depend on the judicious use of resuscitative fluids and respiratory support. The rôles of supplementary oxygen and assisted ventilation remain controversial although administration of high inspired oxygen concentrations and respiratory support may be unavoidable. The advantage of pharmacological manipulation of reflex mechanisms is as yet unproven. Hyperbaric therapy may improve survival in pulmonary blast injury.