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DD,
PBI (pulmonary blast injury) - Lung
Pulmonary contusion
– Worse on side of approach of blast waves in open air.
– Bilateral and diffuse when victim is located in confined space.
Degree of pulmonary pathology is proportional to the velocity of chest wall displacement.
PBI to lung is referred to as blast lung.
Greater incidence in confined spaces
Major cause of death in PBI’s
Alveolar membranes torn
Minimal to massive hemorrhage with hemothorax or air emboli
Treatment similar to Pulmonary Contusion.
Studies have shown no long term effects
Generally normal after 1 year
PBI - Hypotension
Bradycardia and hypotension without hemorrhage.
– Blast loads directly at the chest cause a unique vagal nerve-mediated form of cardiogenic shock without compensatory vasoconstriction.
– Occurs within seconds and resolves over 1 – 2 hours.
PBI – Arterial Air Embolus (AAE)
Hemopneumothoraces, traumatic emphysema, and alveolovenous fistulas from stress-induced tears of air-tissue interfaces.
Lead directly to bronchopleural fistulas or Arterial Air Embolus (AAE).
PBI - AAE
AAE to the brain or head may be the most common cause of rapid death caused solely by PBI in immediate survivors.
May be precipitated by positive-pressure ventilation (PPV).
Often occurs at the moment of PPV.
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'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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