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Bomb Blast Injuries


Blast injuries are divided into four classes: primary, secondary, tertiary, and quaternary.

  1. Primary injuries- Primary injuries are caused by blast overpressure waves, or shock waves.
    1. AIR BLAST: The ears (Tympanic membrane rupture and middle ear damage) are most often affected by the overpressure, followed by the lungs and the hollow organs of the gastrointestinal tract.
      Blast lung refers to severe pulmonary contusion, bleeding or swelling with damage to alveoli and blood vessels, or a combination of these.
    2. UNDERWATER BLAST: When the explosion is in the water, the pressure changes are called underwater  blast. Injuries occur mostly in GIT and less commonly in lungs.
    3. Solid blast refers to a wave of energy that spreads through a rigid structure when an explosive is detonated near it and people near to it are injured. Steel construction of tanks conduct shock wave well and cause Solid blast injury. The injuries are mostly skeletal. Fracture of legs and vertebral column are more common. 
  2. Secondary injuries
    1. Secondary injuries are due people being injured by shrapnel and other objects propelled by the explosion. 
    2. Most casualties are caused by secondary injuries. In some instances, the target provides the raw material for the objects thrown into people, e.g., shattered glass from a blasted-out window or the glass facade of a building.
    3. The blast may drive multiple fragments of bomb or pieces of nearby objects through air into the skin and cause bruises, abrasions and puncture lacerations intimately mixed on the skin. This triad of injury is diagnostic. Most of the bruises, lacerations and puncture lacerations are less than 1.0 cm.
    4. The triad of bruise, Abrasion, Puncture laceration is called peppering  
  3. Tertiary injuries
    1. Displacement of air by the explosion creates a blast wind that can throw victims against solid objects.
    2. Injuries resulting from this type of traumatic impact are referred to as tertiary blast injuries.  
  4. Quaternary injuries (Miscellaneous injuries)
    1. Quaternary injuries, or other miscellaneous named injuries, are all other injuries not included in the first three classes.
    2. These include flash burns, crush injuries, falling masonry and respiratory injuries.
    3. Falling masonry (collapse of building) can cause traumatic asphyxia.
    4. Psychiatric injury, some of which may be caused by neurological damage incurred during the blast, is the most common quaternary injury.

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