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Abdominal and Genitourinary Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
In civilian practice, blast injury is very rare outside terror attacks and war zones.16 Blast injury consists of a combination of mechanisms including primary blast injury due to the effects of overpressure, secondary injury from flying debris, tertiary injury from the patient being moved by the blast and other injuries including burns and the effects of chemical, biological and radiological contamination of blast injury victims. The latter may manifest significant time after the initial injury. Blast is covered in more detail in Chapter 26.
Patterns of Injury
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Danyal Magnus, Katherine A. Brown, Mansoor Khan, William G. Proud
To link the casualties to injury mechanism and scenario, the following tables give a summary of types of injury seen and the scenarios. Further details on the types and causes of injury form the second section of this chapter. In medical literature, the types of blast injury are classified into four groups: primary are injuries associated with the blast wave alone, secondary are due to fragments or projectiles thrown by the blast, tertiary are due to the human body being thrown against other objects, and quaternary include burns, toxic shock, and acts as a catch-all class for injury types which are not mechanical in nature (Tables 2.2 and 2.3).
Contact sport and blast-related neuropathology
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
Daniel du Plessis, Christopher Milroy
Blast injury results in the rapid transmission of acoustic waves through the brain. It has been recognised for over 100 years that exposure to blast injury is associated with neurological disorders (Shively and Perl 2017; Kinch et al. 2019). In the First World War of 1914–1918, many servicemen were diagnosed with a neurological disorder called neurasthemia and ‘shell shock’, but correlative neuropathological studies were lacking. It is reported that 8.4 per cent of the US military serving in the Afghanistan and Iraq wars suffered TBI, most of these caused by blast injury (DePalma and Hoffman 2018). CTE has been described in military veterans (Goldstein et al. 2012; McKee and Robinson 2014). In contrast, a preliminary study of brain specimens of military personnel, including 43 with a history of TBI and three with a history of blast exposure did not identify changes associated with CTE (Tripathy et al. 2019). A history of non-blast-related head trauma in some cases further confounds establishing a causal relationship between blast exposure and CTE (Shively and Perl 2017). Single-blast exposure has resulted in injury in animal models with evidence of tau-related pathology. While sports-related trauma is relatively predictable, blast injury represents heterogenous circumstances, as injury may occur in closed or open environments such as buildings and vehicles or in open areas. The explosive charge will also vary as these are often improvised explosive devices. The blast may represent a single incident or repeated exposure to blast injury.
Nanoparticle-based drug delivery for the treatment of traumatic brain injury
Published in Expert Opinion on Drug Delivery, 2023
Farrah S. Mohammed, Sacit Bulent Omay, Kevin N. Sheth, Jiangbing Zhou
Blast-like injury models, apart from open field designs, represent another tunable and highly reproducible set of TBI models. The penetrating ballistic brain injury model represents the focal damage shrapnel from an explosion can cause where a cavity forms corresponding to the penetration location [116]. Most other blast injury models reflect mechanisms of diffuse and mixed injuries. Blast tube models employ the detonation of an explosive to simulate a shock wave and blast wind without reflected shock fronts from the ground and other surfaces. When designing these experiments researchers must consider accommodations for the model organism, intended placement of the organism within or away from the tube/subject standoff, and plan for specialized testing locations and personnel training for the safe use of explosives. Common models include the Parks tube, often used in swine models [117,118], and the Clemedson tube [119] which can be used to study blast injury in rats [120,121]. Shock-wave primary blast injury models are similar except that they use compressed gas instead of explosives, though the physics of gas-driven shock waves may differ from explosive shock waves and the resulting pathology may not accurately reflect that of the human condition [122].
The Marcus Institute for Brain Health: an integrated practice unit for the care of traumatic brain injury in military veterans
Published in Brain Injury, 2021
Catharine H. Johnston-Brooks, Riley P. Grassmeyer, Christopher M. Filley, James P. Kelly
Traumatic brain injury (TBI), a major health problem around the world, has been termed a “signature wound” of recent military conflicts (1). Between 2000 and 2019, over 413,000 United States service members were identified as having at least one service-related TBI, the vast majority of which (82%) were considered mild or mTBI (2). These injuries can occur from the impact of a head striking a fixed object, an object striking the head with or without skull penetration, a whiplash effect injury, or a blast. Blast injury is unique in that, in addition to the primary damage caused by the force of the blast wave, there can be secondary (airborne debris) as well as tertiary (transposition of the body or structural collapse) injuries (3). As there are currently no biomarkers that can reliably identify TBI, the diagnosis is founded on report or observation of the injury event. Specifically, the event must include at least one of the following: loss of consciousness of less than 30 minutes, post-traumatic amnesia of less than 24 hours, or an alteration of consciousness (4). Common persistent post-concussion symptoms (PPCS) following mTBI include physical complaints (e.g., headache, dizziness, sleep disturbance, and fatigue); cognitive deficits (e.g., inattention, poor concentration, impaired memory, and executive dysfunction); and behavioral change(s) and/or alterations in degree of emotional responsivity (e.g., irritability, disinhibition, and emotional lability). These symptoms cannot be accounted for by a psychological reaction to physical or emotional stress alone (5).
Quantitative analysis of the global proteome in lung from mice with blast injury
Published in Experimental Lung Research, 2020
Ying Liu, Yunen Liu, Changci Tong, Peifang Cong, Xiuyun Shi, Lin Shi, Mingxiao Hou, Hongxu Jin, Yongli Bao
Blast injury is mainly caused by the primary shock wave. The internal organs present at the gas-liquid interface can be severely damaged.13 Although proteomic analysis following low-intensity blast-induced mild traumatic brain injury has been reported, the critical players involved in blast-induced acute lung injury is not clear. The significance of this study is highlighted by an urgent need to identify mice responses to lung injury at the molecular level.14,15 Based on the proteomic profiles of mouse lung exposed to blast, we are exploring novel targets and candidate proteins linked to acute lung injury. Biological process enrichment shown that the disruption of key canonical pathways. Enrichment pathways found these changes included multiple proteins associated with thermogenesis, complement and coagulation cascades, amino sugar metabolism, nucleotide sugar metabolism, oxidative phosphorylation and so on. These dysfunctions are related to the relevant enzyme activities. Thus, it is important to obtain the proteomic profiles of lung from mice suffered blast, these will provide a basis for the diagnosis and treatment.