Book contents
- Frontmatter
- Contents
- Contributors
- Foreword
- Preface
- Introductory Notes
- 1 Physiology of ventilation and gas exchange
- 2 Assessing the need for ventilatory support
- 3 Oxygen therapy, continuous positive airway pressure and non-invasive ventilation
- 4 Management of the artificial airway
- 5 Modes of mechanical ventilation
- 6 Oxygenation
- 7 Carbon dioxide balance
- 8 Sedation, paralysis and analgesia
- 9 Nutrition in the mechanically ventilated patient
- 10 Mechanical ventilation in asthma and chronic obstructive pulmonary disease
- 11 Mechanical ventilation in patients with blast, burn and chest trauma injuries
- 12 Ventilatory support: extreme solutions
- 13 Heliox in airway obstruction and mechanical ventilation
- 14 Adverse effects and complications of mechanical ventilation
- 15 Mechanical ventilation for transport
- 16 Special considerations in infants and children
- 17 Tracheostomy
- 18 Weaning, extubation and de-cannulation
- 19 Long-term ventilatory support
- 20 The history of mechanical ventilation
- Glossary
- Index
11 - Mechanical ventilation in patients with blast, burn and chest trauma injuries
Published online by Cambridge University Press: 14 October 2009
- Frontmatter
- Contents
- Contributors
- Foreword
- Preface
- Introductory Notes
- 1 Physiology of ventilation and gas exchange
- 2 Assessing the need for ventilatory support
- 3 Oxygen therapy, continuous positive airway pressure and non-invasive ventilation
- 4 Management of the artificial airway
- 5 Modes of mechanical ventilation
- 6 Oxygenation
- 7 Carbon dioxide balance
- 8 Sedation, paralysis and analgesia
- 9 Nutrition in the mechanically ventilated patient
- 10 Mechanical ventilation in asthma and chronic obstructive pulmonary disease
- 11 Mechanical ventilation in patients with blast, burn and chest trauma injuries
- 12 Ventilatory support: extreme solutions
- 13 Heliox in airway obstruction and mechanical ventilation
- 14 Adverse effects and complications of mechanical ventilation
- 15 Mechanical ventilation for transport
- 16 Special considerations in infants and children
- 17 Tracheostomy
- 18 Weaning, extubation and de-cannulation
- 19 Long-term ventilatory support
- 20 The history of mechanical ventilation
- Glossary
- Index
Summary
Blast injuries
The recent increase in terrorist bomb attacks on urban civilian targets in Europe and the USA has emphasized the need for all relevant health provision team members to become familiar with the pathophysiology and treatment of the resulting injuries. Despite this, many surgeons and intensivists have little direct experience treating blast lung injuries.
The physics of explosions
Explosive devices instantaneously transform the explosive material into a highly pressurized gas, releasing energy at supersonic speeds (high order explosives) or subsonic speeds (low order explosives). High order explosives include Semtex, trinitrotoluene (TNT) and dynamite. Low order explosives include pipe bombs, petrol bombs or blasts caused by aircraft or motor vehicles used as missiles. The net result of any explosion, however, is the blast wave that travels out from the epicentre of the blast.
The blast wave rapidly reaches a peak (3 to 5 atmospheres) and then slowly (2 to 3 minutes) declines to sub-atmospheric pressure. The physical characteristics of the blast wave may be described in terms of velocity, wavelength and amplitude. It is the amplitude of the blast wave that principally determines the severity of the resulting lung injury. When compared with an explosion in an open space, an explosion within a confined space, such as inside a bus or a train, will have a blast wave that is amplified and more prolonged, resulting in injuries of greater severity and mortality.
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- Chapter
- Information
- Core Topics in Mechanical Ventilation , pp. 210 - 221Publisher: Cambridge University PressPrint publication year: 2008