![]() ![]() Children are at particularly high risk of tertiary injury due to their relatively smaller body weight. ![]() Tertiary injuries may present as some combination of blunt and penetrating trauma, including bone fractures and coup contre-coup injuries. Injuries resulting from this type of traumatic impact are referred to as tertiary blast injuries. Tertiary injuries ĭisplacement of air by the explosion creates a blast wind that can throw victims against solid objects. In other instances, the target provides the raw material for the fragments thrown into surrounding, e.g., shattered glass from a blasted-out window or the glass facade of a building. Some explosives, such as nail bombs, are deliberately designed to increase the likelihood of secondary injuries. Most casualties are caused by secondary injuries as shrapnels generally affect a larger area than the primary blast area, because as debris can easily be propelled for hundreds or even thousands of meters. Secondary blast wounds may be lethal and therefore many anti-personnel explosive devices are designed to generate fast-flying fragments. However, there may be extensive blood loss within the body cavities. At times the propelled object may become embedded in the body, obstructing the loss of blood to the outside. These injuries may affect any part of the body and sometimes result in penetrating trauma with visible bleeding. Secondary injuries are ballistic trauma caused by impacts of flying shrapnels and other objects propelled by the explosion. It is the most common cause of death among people who initially survive an explosion. Blast lung refers to severe pulmonary contusion, bleeding or swelling with damage to alveoli and blood vessels, or a combination of these. Thus, the majority of prior research focused on the mechanisms of blast injuries within gas-containing organs and organ systems such as the lungs, while primary blast-induced traumatic brain injury has remained underestimated. There is general agreement that spalling, implosion, inertia, and pressure differentials are the main mechanisms involved in the pathogenesis of primary blast injuries. According to the latest experimental results, the extent and types of primary blast-induced injuries depend not only on the peak of the overpressure, but also other parameters such as number of overpressure peaks, time-lag between overpressure peaks, characteristics of the shear fronts between overpressure peaks, frequency resonance, and electromagnetic pulse, among others. In general, primary blast injuries are characterized by the absence of external injuries thus internal injuries are frequently unrecognized and their severity underestimated. The combination of these effects can lead to hearing loss, tinnitus, headache, vertigo (dizziness), and difficulty processing sound. Therefore, affected individuals can have auditory processing deficits while having normal hearing thresholds. Additionally, the intensity of the pressure changes from the blast can cause injury to the blood vessels and neural pathways within the auditory system. Furthermore, the hair cells, the sound receptors found within the cochlea, can be permanently damaged and can result in a hearing loss of a mild to profound degree. The tympanic membrane (also known as the eardrum) may be perforated by the intensity of the pressure waves. Įxtensive damage can also be inflicted upon the auditory system. By increasing the pressure or its duration, the severity of injury will also increase. Injury from blast overpressure is a pressure and time dependent function. Gastrointestinal injuries may present after a delay of hours or even days. The ears are most often affected by the overpressure, followed by the lungs and the hollow organs of the gastrointestinal tract. Primary injuries are especially likely when a person is close to an exploding munition, such as a land mine. Total body disruption is the most severe and invariably fatal primary injury. Primary injuries are caused by blast overpressure waves, or shock waves. ![]() These injuries are compounded when the explosion occurs in a confined space.Ĭlassification Diagram of a blast injuryīlast injuries are divided into four classes: primary, secondary, tertiary, and quaternary. Blast injuries occur with the detonation of high-order explosives as well as the deflagration of low order explosives. Murrah Federal Building from the April 1995 Oklahoma City bombingĪ blast injury is a complex type of physical trauma resulting from direct or indirect exposure to an explosion. Floor-by-floor breakdown of the injuries/deaths in the Alfred P. ![]()
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