Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-03T00:56:16.883Z Has data issue: false hasContentIssue false

11 - Mechanical ventilation in patients with blast, burn and chest trauma injuries

Published online by Cambridge University Press:  14 October 2009

Iain Mackenzie
Affiliation:
Addenbrooke's Hospital, Cambridge
Get access

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.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×