Explosive Blast Injuries : Principles and Practices

Preface Contents Contributors About the Editors Part I: General Introduction Introduction and Epidemiology 1 Overview of Explosive Blast Injury 2 Physical Parameters and Biomechanical Mechanisms of Injury from Blast Wave 2.1 Physical Parameters of Injury from Blast Wave 2.2 Biomechanical Mechanisms of Injury from Blast Wave 3 Types of Blast Injuries 3.1 Classification of Blast Injury Cause 3.2 Classification of Shock Wave Propagation Medium 3.3 Classification of Body Part and Organ Injured 3.4 Classification of Injury Severity 4 Epidemiological Features of Blast Injury 4.1 General Features of Blast Injury 4.2 Incidence Rate and Fatality Rate of Blast Injury 5 Principles for Treatment of Blast Injury 5.1 Light Blast Injury 5.2 Moderate Blast Injury 5.3 Severe Blast Injury 5.4 Extremely Severe Blast Injury Explosion Physics 1 Basic Knowledge About Explosives 1.1 Types of Explosives 1.2 Characteristics of Explosives 1.3 Application of Explosives 1.3.1 Military Usage 1.3.2 Civil Usage 1.3.3 Military-Civil Usage 2 Basic Knowledge About Detonation 2.1 The Detonation Process 2.2 Basics About Shock Waves and Blast Waves 2.2.1 Basics About Shock Waves 2.2.2 Basics About Detonation Wave 2.3 Sensitivity of Explosives to External Effects 2.3.1 Heat Sensitivity 2.3.2 Mechanical Sensitivity 2.3.3 Shock Sensitivity 3 Propagation of Detonation 3.1 Propagation of Detonation in Condensed Explosive 3.2 Propagation of Detonation in Gas Phase and Mixed Phase Explosives 4 Effects of Detonation 4.1 Drive and Loading of Detonation 4.1.1 Drive of Metal Cylinder by Internal Explosion Load 4.1.2 Drive of Flat Plate by Detonation 4.2 Explosion in Air 4.2.1 Formation of Blast Wave 4.2.2 Similarity Theory in Explosion 4.2.3 Obstacle’s Reflection, Transmission, and Diffraction of Blast Wave 4.3 Underwater Explosion 4.4 Explosion in Rock and Soil 4.5 Thermal Effects of Explosion 4.5.1 Temperature of Detonation Product 4.5.2 Temperature Increase Effect of Adiabatic Compressed Air Behind Blast Wave 4.5.3 Thermal Radiation Effects of Fuel/Air Mixture Explosion Bibliography Explosion and Injuring Factors 1 Types of Explosion 1.1 Physical Explosion 1.2 Chemical Explosion 1.3 Nuclear Explosion 1.4 Common Types of Explosives 2 Formation and Progression of Shock Wave 2.1 Formation of Shock Wave When Explosive Explodes 2.2 Formation of Shock Wave in Nuclear Explosion 2.3 Formation of Shock Wave in Shock Tube Experiment 2.4 Movement of Shock Wave 3 Similarities and Differences Between Shock Wave of Nuclear Explosion and Explosive Explosion 3.1 Similarities 3.2 Differences 4 Factors That Decide and Influence Shock Wave Injury Capacity 4.1 Physical Parameters That Influence Shock Wave Injury Capacity 4.2 Influence of Explosion Conditions on Shock Wave 4.3 Influence of Personnel Conditions on Blast Injury 4.4 Influence of Environmental Conditions on Blast Injury 5 Evaluation of Injury Effect of Shock Wave on Humans 5.1 Criteria of Damage of Shock Wave 5.2 Injury Effects of Blast Wave on Humans 5.3 Blast Wave Damage and Injury Zones Bibliography Injury Principles and Mechanisms of Shock Wave 1 Injury Principles of Shock Wave 2 Injury Mechanisms of Shock Wave Bibliography Mechanical Mechanisms and Simulation of Blast Wave Protection 1 Mechanical Mechanisms of Blast Wave and Protection Requirements 2 Shock Wave Energy Dissipation Mechanisms in Multiscale Microstructure of Composite Materials 3 Resistance Property Matching and Chemical Design of Material Interface Related to Blast Wave Propagation 4 Injury Mechanisms and Tolerance Thresholds of Blast Wave 5 Mechanical Model and Simulation of Blast Wave Protection 6 Temporal and Spatial Propagation Mechanisms of Blast Wave Bibliography Biological Shock Tube 1 Basic Knowledge About Biological Shock Tube 1.1 Shock Wave and Rarefaction Wave 1.2 Theoretical Equations of Shock Tube 1.3 Shock Tube Technologies in Shock Wave Protection Research 1.3.1 Key Issues in Shock Wave Protection 1.3.2 Application of Shock Tube Technology 2 Categories and Features of Biological Shock Tubes 2.1 Technical Requirements of Biological Shock Tubes 2.2 Categories of Biological Shock Tubes 2.3 Variable Cross-Section Shock Tube 2.3.1 Uniform Cross-Section Shock Tube 2.3.2 Combination Shock Tube 2.3.3 Explosive-Driven Biological Shock Tube 2.3.4 Micro Shock Tube 2.4 Features of Biological Shock Tube 2.4.1 Advantages 2.4.2 Disadvantages 3 Development and Application of Biological Shock Tubes in China 3.1 Design Principle and Technical Proposal for the First Biological Shock Tubes in China 3.1.1 Design Proposal 3.1.2 Principles Behind Generation of Blast Wave 3.1.3 Other Technical Proposals 3.2 Research, Production, and Application of Serial Biological Shock Tube 3.2.1 Research, Production, and Design Principles of Serial Biological Shock Tube 3.2.2 Biological Experiments 3.3 Others Bibliography Defense Against Blast Injury 1 History and Status Quo of Blast Injury Protection 2 Key Factors in Blast Injury Protection 3 Blast Injury Protection of Organs 3.1 Easily Injured Organs 3.2 Defense Against Blast-Induced Traumatic Brain Injury 3.3 Chest and Abdomen Blast Injury Protection 4 Blast Injury Protection Materials 4.1 Material Composition 4.2 Material Structure 4.2.1 Two-Layer Material Combination Structure 4.2.2 Three-Layer Material Combination Structure 4.2.3 Multilayer Combination Structure 4.2.4 Fiber-Wrapped Composite Enhanced Combination Structure 5 Blast Injury Protection Equipment 5.1 Protection Equipment for Head 5.2 Protection Equipment for Chest and Abdomen 5.3 Protection Equipment for Pelvis 5.4 Protection Equipment for Auditory Apparatus 5.5 Protection Equipment for Feet 6 Protection Measures Against Blast Injury 6.1 Planning, Design, and Protection Education 6.1.1 Planning and Design of Storage for Explosives 6.1.2 Education About Protection from Explosives and Dangerous Items 6.2 Establishment of Man-Made Barriers 6.2.1 Explosion-Proof Retaining Walls 6.2.2 Bubble Curtain 6.2.3 Impact-Proof and Shock-Absorbing Device 6.3 Protection of Fortifications 6.3.1 Open-Air Fortifications 6.3.2 Covered Fortifications 6.3.3 Air Raid Shelter 6.3.4 Permanent Fortifications 6.4 Protection of Weaponry 6.4.1 Armored Vehicles 6.4.2 Naval Vessel Compartment 7 Blast Injury Protection Bottlenecks 8 The Future of Blast Injury Protection 9 Conclusion and Vision Bibliography Diagnosis of Blast Injury 1 Medical History Collection of Blast Injury 1.1 Medical History Collection of Blast Injury 1.2 Clinical Manifestations of Blast Injury in Various Organs 1.2.1 Blast Lung Injury 1.2.2 Gastrointestinal Blast Injury 1.2.3 Auricular Blast Injury 1.2.4 Clinical Manifestations of Other Blast Injuries 2 Imaging and Laboratory Examination 2.1 Imaging and Laboratory Examination of Blast Lung Injury 2.1.1 Imaging Examination 2.1.2 Laboratory Examination 2.2 Imaging and Laboratory Examination of Gastrointestinal Blast Injury 2.2.1 Imaging Examination 2.2.2 Laboratory Examination 2.3 Imaging and Laboratory Examination of Auricular Blast Injury 2.3.1 Imaging Examination 2.3.2 Laboratory Examination 2.4 Imaging and Laboratory Examination of Other Blast Injuries 2.4.1 Imaging and Laboratory Examination of Ocular Blast Injury 2.4.2 Imaging and Laboratory Examination of Other Thoracic Blast Injuries 2.4.3 Imaging and Laboratory Examination of Blast-Induced Traumatic Brain Injury 3 Key Points for Diagnosis of Blast Injury 3.1 Assessment of Severity of Blast Injury 3.2 Key Points for Diagnosis of Common Blast Injuries 3.2.1 Blast Lung Injury 3.2.2 Gastrointestinal Blast Injury 3.2.3 Auricular Blast Injury 3.2.4 Other Blast Injuries Bibliography Medical Treatment in Echelons of Blast Injury 1 Summary of Medical Treatment in Echelons Theory 1.1 History of Medical Treatment in Echelons Theory 1.2 Main Content of Classic Medical Treatment in Echelons Theory 1.3 Basic Viewpoints of Medical Treatment in Echelons Theory 1.3.1 Certain Applicable Environment and Conditions for Medical Treatment in Echelons 1.3.2 The Basic Characteristic of Medical Treatment in Echelons Is Step and Continuous Organization and Implementation with Labor Division 1.3.3 Medical Treatment in Echelons Is a Theoretical Principle 1.3.4 Determine Echelons Based on the Technical System as the Main Line 1.3.5 During the Medical Treatment in Echelons, First Aid Is the Key, and Definitive Treatment Is the Foundation 1.4 Basic Requirements for the Medical Treatment in Echelons of Blast Injuries 1.4.1 Rescue the Wounded Quickly and Timely for Early Recovery 1.4.2 Make Processes Continuous to Ensure the Quality of Treatment 1.4.3 Complement Each Other by Combining Medical Treatment And Evacuation 2 Types of Medical Treatment in Echelons for Blast Injury 2.1 Kinds of Medical Treatment of Classic War Injury 2.1.1 On-Battlefield (On-Site) First Aid 2.1.2 Medical Treatment 2.1.3 Forward Resuscitative Surgery 2.1.4 Definitive Treatment 2.1.5 Rehabilitative Treatment 2.2 Classification of Treatment for Blast Injury During Wartime 2.2.1 On-Battlefield (On-Site) First Aid for Blast Injury 2.2.2 Medical Treatment for Blast Injury 2.2.3 Forward Resuscitative Surgery of Blast Injury 2.2.4 Definitive and Rehabilitative Treatment of Blast Injury 2.3 Classification of Treatment for Blast Injury in Peacetime 2.3.1 On-Site First Aid for Blast Injury 2.3.2 Key Pre-hospital Treatment for Blast Injury 2.3.3 In-Hospital Comprehensive Treatment for Blast Injury 3 The Main Work of Medical Treatment in Echelons of Blast Injury 3.1 Organizations for Medical Treatment in Echelons of Blast Injury 3.1.1 Organizations for Medical Treatment in Echelons of Blast Injury in Wartime 3.1.2 Organizations for Medical Treatment in Echelons of Blast Injury in Peacetime 3.2 On-Site Treatment Organization for Blast Injury 3.2.1 Organize Treatment in the Killing Zone to Minimize Deaths 3.2.2 Give Priority to the Treatment of the Critically Wounded, and Strive to Reduce the Early Deaths of the Wounded 3.3 Evacuation Organization of the Wounded with Blast Injury 3.3.1 Evacuation Method 3.3.2 Evacuation Tools 3.3.3 Main Measures for Safe Evacuation 3.4 Organization of the Relay Treatment of Blast Injury 3.5 Definitive Treatment and Rehabilitative Treatment of Blast Injury 3.5.1 Effective Control of Shock 3.5.2 Focus on Prevention and Treatment of Wound Infections with Debridement Operations at Appropriate Times 3.5.3 Proper Treatment According to the Characteristics of Blast Injury 3.5.4 Focus on Psychological Trauma to Promote Both Physical and Mental Health First Aid Techniques for Blast Injury 1 On-Site Assessment and First Aid Principles of Blast (Battlefield) Injuries 1.1 On-Site Assessment of Blast Injury 1.1.1 Simple Triage and Rapid Treatment (START) 1.1.2 “ABCDE” and “MARCH” Method 1.2 First Aid Principles of Blast Injury 2 Airway Management of Blast Injury 2.1 Removing Foreign Bodies in the Respiratory Tract 2.2 Glossocoma Relief 2.3 Nasopharyngeal Airway Ventilation 2.4 Thyrocricocentesis 2.5 Cricothyrotomy 2.6 Tracheal Intubation 3 Massive Bleeding Control Technology and First Aids for Shock Due to Blast Injury 3.1 Evaluation of Hemorrhage and Shock 3.1.1 Determine Whether There Is Fatal Hemorrhage 3.1.2 Judgment of Bleeding Volume 3.1.3 Recognition of Shock 3.2 On-Site First Aids for Severe Hemorrhage Caused by Blast Injury 3.2.1 Tourniquet Application for Bleeding Control 3.2.2 Hemostatic Dressing Packing and Compression for Bleeding Control 3.2.3 Direct Compression Hemostasis 3.2.4 Hemostatic Techniques for Closed Massive Abdominal Hemorrhage 3.3 First Aids for Shock 3.3.1 Oral Rehydration 3.3.2 Initiate Fluid Resuscitation Intravenously or Through Marrow Cavity Infusion Channels, If Conditions Permit 3.3.3 Other Treatments 4 Treatment of Pneumothorax and Hemothorax in Blast Injury 4.1 Recognition and Management of Tension Pneumothorax of Blast Injury 4.1.1 How to Identify Tension Pneumothorax On Site 4.1.2 First Aid for Tension Pneumothorax 4.2 Recognition and Treatment of Open Pneumothorax of Blast Injury 4.2.1 How to Identify Open Pneumothorax On Site 4.2.2 On-Site First Aid for Open Pneumothorax 4.3 Recognition and Treatment of Massive Hemothorax of Blast Injury 4.3.1 How to Identify Massive Hemothorax 4.3.2 On-Site First Aid for Massive Hemothorax 5 Bandaging and Fixation of Blast Injury 5.1 Open Neck Injury 5.2 Open Brain Injury 5.3 Bandaging of Eye Trauma 5.4 Bandaging Methods at the Junction of the Trunk and Limbs 5.5 How to Bandage a Wound Filled with Foreign Bodies 5.6 Abdominal Viscera Prolapse 5.7 Fixation of Long Bone Fractures 5.8 Fixation of Pelvic Fracture 6 Transportation Techniques in Blast Injury 6.1 Carry by Crawling 6.2 Drag 6.3 Stretcher Transportation 7 Cardiopulmonary Resuscitation Techniques for Blast Injury 7.1 Indications for Cardiopulmonary Resuscitation 7.2 Steps of Cardiopulmonary Resuscitation Blast Injury Management and Treatment in ICU 1 Intensive Monitoring 1.1 Basic Vital Signs Monitoring 1.2 Hemodynamic Monitoring 2 Respiratory Support for Blast Injury 2.1 Oxygen Therapy 2.2 Noninvasive Positive Pressure Ventilation 2.3 Invasive Mechanical Ventilation 2.4 Liquid Ventilation 2.5 Extracorporeal Membrane Oxygenation (ECMO) Bibliography Blast Trauma Care 1 On-Site Assessment and Management of Blast Injuries 1.1 Assessment of the Detonation Site 1.2 Emergency Management at the Detonation Site 2 In-Hospital Management and Care for Common Blast Injury 2.1 Key Points of In-Hospital Emergency Management 2.1.1 Management Plan 2.1.2 Emergency Management Strategy 2.1.3 Routine Care Measures 2.2 Care of Common Blast Injuries 2.2.1 Care of Blast Lung Injury 2.2.2 Care of Gastrointestinal Blast Injury 2.2.3 Care of Tympanic Membrane Blast Injury 2.2.4 Care of Other Blast Injuries Bibliography Psychological Intervention and Therapy After Blast Injury 1 Overview on Psychological Crisis and Intervention 1.1 Definitions of Psychological Crisis and Intervention 1.2 Models, Techniques, and Implementation Steps for Psychological Intervention and Therapy 1.3 Necessity of Psychological Intervention and Therapy 2 Psychological Intervention and Therapy for Survivors of Blast Injuries 2.1 Psychological Characteristics of Survivors 2.2 Causes for Psychological Issues in Survivors 2.3 Psychological Intervention and Therapy Techniques for Survivors 3 Psychological Intervention and Therapy for Families of Explosion Casualties 3.1 Psychological Characteristics of Families of Accident Casualties 3.2 Psychological Intervention and Therapy for Families of Accident Casualties 4 Psychological Intervention and Therapy for Rescuers in Explosions 4.1 Psychological Characteristics of Rescuers 4.2 Psychological Intervention and Therapy for Rescuers Part II: Key Complications and Their Treatment Hemorrhagic Shock 1 Pathophysiological Characteristics and Mechanisms of Hemorrhagic Shock Caused by Blast Injury 1.1 Pathophysiological Characteristics of Shock Due to Blast Injury 1.2 Cardiovascular Dysfunction and Mechanisms of Shock Induced by Blast Injury 1.2.1 Hemodynamic Disorder and Mechanism 1.2.2 Cardiac Dysfunction and Mechanism 1.2.3 Vascular Dysfunction and Mechanism 1.2.4 Microcirculation Dysfunction and Mechanisms 2 Assessment and Monitoring of the Hemorrhagic Shock Caused by Blast Injury 2.1 Diagnosis and Assessment of Hemorrhagic Shock 2.2 Monitoring of Functions of Organs in Shock 2.2.1 Vital Signs Monitoring 2.2.2 Hemodynamic Monitoring 2.2.3 Tissue Perfusion and Oxygenation Monitoring 3 Prevention and Treatment of Hemorrhagic Shock Caused by Blast Injury 3.1 Hemostasis and Fluid Resuscitation 3.2 Resuscitation Fluid Selection 3.3 Vasoactive Drugs 3.4 Heart Function Enhancement 3.5 Microcirculation Improvement 3.6 Acidosis Correction 3.7 Recovery of Vascular Hyporesponsiveness in Shock Bibliography Infection and Sepsis 1 General Concepts 1.1 Infection 1.2 Surgical Infection 1.3 Bacteremia 1.4 Toxemia 1.5 Septicemia 1.6 Systemic Inflammatory Response Syndrome (SIRS) 1.7 Sequential Organ Failure Assessment (SOFA) 1.8 Sepsis 1.9 Systemic Infection 1.10 Multiple Organ Dysfunction Syndrome (MODS) 2 Main Pathogens of Trauma Infection 2.1 Evolution of Major Pathogens 2.2 Origin and Invasive Route of Trauma Infection Pathogens 2.3 Clinical Significance of Bacterial Count 3 Main Types of Trauma Infection 3.1 Post-traumatic Suppurative Infection 3.1.1 Clinical Manifestations 3.1.2 Diagnosis 3.1.3 Treatment Plan and Principles 3.2 Post-traumatic Tetanus 3.2.1 Etiology and Pathogenesis 3.2.2 Clinical Manifestations and Diagnosis 3.2.3 Prevention 3.2.4 Treatment 3.3 Post-traumatic Gas Gangrene 3.3.1 Etiology and Pathogenesis 3.3.2 Clinical Manifestations and Diagnosis 3.3.3 Treatment 3.3.4 Prevention 3.4 Invasive Streptococcal Infection 3.4.1 Etiology 3.4.2 Pathogenesis 3.4.3 Clinical Manifestations 3.4.4 Diagnosis 3.4.5 Treatment 3.4.6 Prognosis 3.5 Necrotizing Fasciitis 3.5.1 Etiology 3.5.2 Pathogenesis 3.5.3 Clinical Manifestations 3.5.4 Diagnosis 3.5.5 Treatment 3.6 Post-traumatic Sepsis 3.6.1 Pathogenesis 3.6.2 Diagnosis 3.6.3 Prevention and Treatment 3.6.4 Early Warning 4 Principles of Antibiotics 4.1 Basic Principles of Antibiotic Prophylactic Application 4.1.1 Timing of Administration 4.1.2 Antibiotic Selection 4.1.3 Dosage 4.1.4 Treatment Course 4.1.5 Administration Route 4.2 Basic Principles of Antibiotic Therapy 4.2.1 Bacterial Strain Analysis According to the Wound Site 4.2.2 Bacterial Strain Analysis Combined with Local Conditions 4.2.3 Bacterial Strain Analysis Combined with Conditions 4.2.4 Antibiotics Selection for Pathogenic Bacteria 4.2.5 Drugs Selection According to Its Tissue Distribution 5 Principles of Medical Treatment in Echelons of Trauma Infection 5.1 Medical Treatment in Echelons of War Wounds 5.2 Management Principles for Prevention and Treatment of War Wound Infection 5.3 Problems to Be Solved Bibliography Trauma-Induced Coagulopathy 1 Overview 2 Pathogenesis 2.1 Classic Trigger Factors 2.1.1 Hemodilution 2.1.2 Hypothermia 2.1.3 Acidemia and Hypoperfusion 2.2 Early TIC Mechanism 2.2.1 DIC-Fibrinolysis Hypothesis 2.2.2 Activated Protein C Hypothesis 2.2.3 Glycocalyx Hypothesis 2.2.4 Fibrinogen-Centric Hypothesis 2.3 Others 3 Diagnosis 3.1 Laboratory Diagnosis 3.1.1 Classical Coagulation Tests (CCT) 3.1.2 Viscoelastic Hemostatic Assays (VHA) 3.1.3 Platelet Function Analysis 3.2 Clinical Diagnosis 4 Treatment and Outcome 4.1 DIC with Fibrinolytic Phenotype 4.2 Severe Hemorrhage and Hemorrhagic Shock 4.2.1 Damage Control Surgery and Permissive Hypotension 4.2.2 Goal-Directed Hemostatic Resuscitation 4.2.3 Fixed Proportion of Blood Product Transfusion 4.2.4 Fibrinogen Concentrate 4.2.5 Prothrombin Complex Concentrate (PCC) and Recombinant Human Activated Factor VII (rFVIIa) 4.3 Other Drugs 5 Conclusion References Further Reading Multiple Organ Dysfunction Syndrome 1 Evolution of Concepts 2 Epidemiology 2.1 Pattern Recognition and Signal Transduction Receptor 2.2 Cytokine 2.3 Coagulation Factor 3 Pathogenesis and Pathophysiology 3.1 Inflammatory Response and Tissue Injury 3.2 Anti-Inflammatory Response 3.3 Persistent Inflammation, Immunosuppression, and Catabolism 4 Pathological Changes 4.1 Lungs 4.2 Heart 4.3 Microcirculation 4.4 Gastrointestinal Tract 4.5 Liver 4.6 Kidneys 4.7 Nervous System 5 Clinical Manifestations and Diagnosis 5.1 Clinical Manifestations 5.2 Diagnosis 6 Treatment Principles 6.1 Removal of Primary Cause 6.2 Removal or Antagonism of Endotoxins 6.3 Neutralization and Antagonism of Inflammatory Mediators 6.3.1 TNF-α Monoclonal Antibody 6.3.2 IL-1 Receptor Antagonist 6.3.3 PAF Receptor Antagonists 6.3.4 Arachidonic Acid Production Inhibitors 6.3.5 Medications to Inhibit or Resist the Release of Toxic Mediators by Neutrophils 6.3.6 Antithrombin III 6.3.7 Plasminogen Activators 6.3.8 Growth Factor 6.4 Glucocorticoid 6.5 Prevention and Treatment of DIC 6.5.1 Heparin or Low Molecular Weight Heparin 6.5.2 Anticoagulation with Recombinant Human Activated Protein C (rhAPC) 6.6 Supportive and Symptomatic Treatment 6.6.1 Supply Adequate Nutrition and Keep Homeostasis 6.6.2 Correct the Imbalance between Oxygen Supply and Demand 6.6.3 Organ Function Support Bibliography Stress Disorder After Blast Injury 1 Epidemiological Characteristics of Stress Disorder After Blast Injury 2 Pathogenetic Mechanism of Stress Disorder After Blast Injury 3 Categories and Diagnosis of Clinical Stress Disorders After Blast Injury 3.1 Acute Stress Disorder 3.1.1 Clinical Signs 3.1.2 CCMD-3 Diagnosis Standards 3.1.3 Differential Diagnosis 3.2 Post-traumatic Stress Disorder 3.2.1 Post-traumatic Stress Disorder from Blast Injury to the Head 3.2.2 Post-traumatic Stress Disorder from Blast Injury Without Head Injury Injuring Mechanism Clinical Manifestations Diagnosis Standards Differential Diagnosis 3.2.3 Post-blast Injury Adjustment Disorder Etiology and Pathogenesis Clinical Categories and Diagnosis CCMD-3 Diagnosis Standards Symptom Standard Differential Diagnosis 4 Post-blast Injury Stress Disorder in Special Environments 5 Treatment of Post-blast Injury Stress Disorder 5.1 Treatment of Post-blast Injury Acute Stress Disorder and PTSD 5.1.1 Psychological Therapy 5.1.2 Environment Therapy 5.1.3 Drug Therapy 5.1.4 Transcranial Magnetic Stimulation 5.1.5 Other Therapies 5.2 Treatment of Post-blast Injury Adjustment Disorder 5.2.1 Psychological Therapy 5.2.2 Drug Therapy 5.2.3 Transcranial Magnetic Stimulation 6 Prognosis of Post-blast Injury Stress Disorder 7 Prevention of Post-blast Injury Stress Disorder 7.1 Prevention of Post-blast Injury Acute Stress Disorder 7.2 Prevention of Post-blast Injury Stress Disorder in War 8 Research on Protection Against Post-blast Injury Stress Disorder Bibliography Part III: Local Blast Injury Blast Lung Injury 1 The Mechanism of Blast Lung Injury 1.1 Implosion Effect 1.2 Spalling Effect 1.3 Hemodynamic Effect 1.4 Underpressure Effect 1.5 Overexpansion Effect 2 Pathophysiological Changes of Blast Lung Injury 3 Clinical Manifestations and Diagnosis of Blast Lung Injury 4 Classification Criteria for Blast Lung Injury 4.1 Classification According to the Shock Wave Pressure Value and Impulse 4.2 Classification According to Pathological Characteristics 5 Treatment Principles of Blast Lung Injury 5.1 Rest 5.2 Keep the Airway Unobstructed 5.3 Oxygen Therapy 5.4 Positive Pressure Ventilation 5.5 Hyperbaric Oxygen Therapy 5.6 Prevention and Treatment of Pulmonary Edema and Protection of Heart Function 5.7 Prevention and Treatment of Hemorrhage and Infection 5.8 Sedatives and Pain Relievers 5.9 Blood Transfusion and Fluid Infusion 5.10 Choice of Anesthesia 6 Blast Lung Injury Under Special Circumstances 6.1 Plateau Blast Lung Injury 6.2 Underwater Blast Lung Injury 7 Prevention of Blast Lung Injury Hearing Damage Through Blast 1 Blast Damage to the Outer Ear 1.1 Auricular Contusions 1.1.1 Clinical Manifestation and Diagnosis 1.1.2 Treatment Principles and Methods 1.2 Auricular Cuts and Lacerations 1.2.1 Clinical Manifestation and Diagnosis 1.2.2 Treatment Principles and Methods 1.3 Auricle Burns 1.3.1 Clinical Manifestation and Diagnosis 1.3.2 Treatment Principles and Methods 1.4 Damage to the External Auditory Canal 1.4.1 Clinical Manifestation and Diagnosis 1.4.2 Treatment Principles and Methods 2 Blast Damage to the Middle Ear 2.1 Traumatic Tympanic Membrane Perforation 2.1.1 Clinical Manifestation and Diagnosis 2.1.2 Treatment Principles and Methods 2.2 Ossicles Trauma 2.2.1 Clinical Manifestation and Diagnosis 2.2.2 Treatment Principles and Methods 2.3 Mastoid Process Injury 2.3.1 Clinical Manifestation and Diagnosis 2.3.2 Treatment Principles and Methods 3 Blast Damage to the Inner Ear 3.1 Overview 3.1.1 Clinical Manifestation and Diagnosis 3.1.2 Treatment Principles and Methods 3.1.3 Prevention 3.2 Inner Ear Barotrauma 3.2.1 Clinical Manifestation and Diagnosis 3.2.2 Treatment Principles and Methods 3.3 Radiation Damage to the Inner Ear 3.3.1 Clinical Manifestation and Diagnosis 3.3.2 Treatment Principles and Methods 3.4 Damage to the Vestibular System 3.4.1 Clinical Manifestation and Diagnosis 3.4.2 Treatment Principles and Methods 3.5 Perilymph Fistula 3.5.1 Clinical Manifestation and Diagnosis 3.5.2 Treatment Principles and Methods 3.6 Labyrinthine Concussion 3.6.1 Clinical Manifestation and Diagnosis 3.6.2 Treatment Principles and Methods 3.7 Acoustic Trauma 3.7.1 Clinical Manifestation and Diagnosis 3.7.2 Treatment Principles and Methods 3.7.3 Prevention 4 Blast Damage to the Central Auditory Nervous System 4.1 Clinical Manifestation and Diagnosis 4.2 Treatment Principles and Methods 5 Temporal Bone Fracture 5.1 Clinical Manifestation and Diagnosis 5.2 Treatment Principles and Methods 6 Traumatic Facial Paralysis 6.1 Clinical Manifestation and Diagnosis 6.2 Treatment Principles and Methods 7 Summary References Blast-Induced Traumatic Brain Injury 1 Epidemiology 2 Mechanism of Occurrence 3 Classification 4 Pathophysiological Characteristics 5 Neuropathological Changes 5.1 Local Neuropathology 5.2 Cell Neuropathology 5.3 Changes in Molecular Biochemistry 6 Clinical Symptoms and Signs 7 Auxiliary Examination 8 Clinical Diagnosis 9 Differential Diagnosis 10 Treatment Principles Further Reading Ocular Blast Injury 1 Overview 1.1 Essentials of Diagnosis 1.1.1 History Taking 1.1.2 Eye Examination 1.1.3 Diagnostic Imaging 1.1.4 Special Examination of the Eye 1.2 First-Aid Principles 2 Mechanical Ocular Injury Through Blast 2.1 Closed Ocular Blast Injury 2.1.1 Corneal Contusion 2.1.2 Contusion of the Iris and Ciliary Body 2.1.3 Anterior Chamber Hyphema (Hyphema) 2.1.4 Lens Injury 2.1.5 Vitreous Hemorrhage 2.1.6 Traumatic Chorioretinopathy 2.1.7 Traumatic Optic Neuropathy (TON) 2.2 Open Ocular Blast Injury 2.2.1 Penetrating Injury to the Eyeball 2.2.2 Intraocular Foreign Bodies 2.2.3 Eyeball (Globe) Rupture 3 Ocular Blast Injuries Associated with Ocular Chemical Burns 3.1 Acid Burns 3.1.1 Features and Mechanisms of Acid Burns 3.1.2 Classification and Prognosis 3.1.3 Clinical Manifestations 3.1.4 Treatment 3.2 Alkali Burns 3.2.1 Features and Mechanisms of Alkali Burns 3.2.2 Clinical Manifestations 3.2.3 Treatment 4 Blast Injuries in Combination with Thermal Burns of the Eye 4.1 Flame Burns 4.2 Contact Burns 4.3 First Aid and Treatment of Thermal Burns 5 Blast Injuries Complicated by Radiation Damage to the Eye Further Reading Heart Blast Injury 1 Diagnosis of Heart Blast Injury 1.1 Clinical Manifestations 1.2 Auxiliary Examination 1.3 Laboratory Examination 2 Special Manifestations of Heart Blast Injury 2.1 Pericardium Injury 2.2 Coronary Artery Injury 2.3 Heart Rupture 2.4 Ventricular Septal Rupture 2.5 Heart Valve Injury 2.6 Great Vessel Injury 3 Treatment of Heart Blast Injury 3.1 Treatment Principles 3.2 Therapies 3.3 Diagnosis and Treatment Process Further Reading Abdominal Blast Injury 1 Overview 1.1 Classification 1.2 Pathogenesis 1.3 Diagnosis 1.4 Treatment Principles 2 Blast Injury of Abdominal Wall 3 Hollow Organ Blast Injury 3.1 Stomach and Duodenum 3.1.1 Clinical Manifestations 3.1.2 Diagnosis 3.1.3 Treatment 3.2 Small Intestine and Mesentery 3.2.1 Clinical Manifestations 3.2.2 Diagnosis 3.2.3 Treatment 3.3 Colorectal and Anal Canal 3.3.1 Clinical Manifestations 3.3.2 Diagnosis 3.3.3 Treatment 4 Solid Organ Blast Injury 4.1 Liver 4.1.1 Clinical Manifestations 4.1.2 Diagnosis 4.1.3 Treatment 4.1.4 Management of Complications 4.2 Biliary Tract 4.2.1 Clinical Manifestations 4.2.2 Diagnosis 4.2.3 Treatment 4.2.4 Postoperative Complications 4.3 Pancreas 4.3.1 Clinical Manifestation 4.3.2 Diagnosis 4.3.3 Treatment of Pancreatic Blast Injuries 4.3.4 Postoperative Complications and Management 4.4 Spleen 4.4.1 Clinical Manifestation 4.4.2 Diagnosis of Blast Injury to the Spleen 4.4.3 Treatment of Blast Injury to the Spleen 4.4.4 Complications and Management 4.5 Kidney 4.6 Clinical Manifestation 4.6.1 Diagnosis 4.6.2 Treatment 4.6.3 Complications and Management 4.7 Ureter 4.7.1 Clinical Manifestation 4.7.2 Diagnosis 4.7.3 Treatment 4.7.4 Complications and Prognosis 5 Blast Injury of Liquid-Contained Organ 5.1 Gallbladder 5.2 Bladder 5.2.1 Clinical Manifestation 5.2.2 Diagnosis 5.2.3 Treatment 5.2.4 Complications and Management 6 Abdominal Vascular Blast Injury 6.1 Abdominal Great Vessels 6.1.1 Clinical Manifestation 6.1.2 Diagnosis 6.1.3 Treatment 6.2 Retroperitoneum 6.2.1 Clinical Manifestation 6.2.2 Diagnosis 6.2.3 Treatment 6.2.4 Postoperative Complications Part IV: Combined Blast Injury Burn-Blast Combined Injury 1 Overview 1.1 Overview 1.2 Classification 2 Pathophysiological Processes of Burn-Blast Combined Injuries 2.1 High Incidence of Shock 2.2 Serious Infection 2.3 Serious Lung Injury and Respiratory Disorder 2.4 Serious Damage to the Heart and Circulatory Function 2.5 Damage to the Liver and GI Tract 2.6 Renal Dysfunction 2.7 Hematopoietic Function and Peripheral Hemogram Changes 2.7.1 Leukocytes 2.7.2 Erythrocytes 2.7.3 Platelets 2.8 Composition Effect of Burn-Blast Combined Injury 3 Clinical Features and Main Cause of Death from Burn-Blast Combine Injuries 3.1 Clinical Features 3.2 Main Cause of Death 4 Diagnosis of Burn-Blast Combined Injuries 4.1 Medical History 4.2 Signs and Symptoms 4.3 Ancillary Examination 4.4 Determination of Injury Severity 4.4.1 Determination of the Severity of Burns Burn De