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 Depth
4.5 Determination of the Severity of Blast Injuries
5 Treatment of Burn-Blast Combined Injuries
5.1 Therapeutic Principles
5.2 On-Site Treatment Principles
5.3 Early Treatment Principles
5.4 Fluid Therapy
5.5 Other Specific Treatment
5.5.1 Early Management of Burn Wounds
Early Debridement
Eschar Incision and Decompression
Treatment of Burn Wounds
5.5.2 Treatment of BBCI Accompanied by Soft Tissue Injuries
5.5.3 Treatment of BBCI with Fractures
5.5.4 Other Specific Treatment
Bibliography
Projectile-Blast Combined Injury
1 Overview
2 Pathophysiology of Projectile-Blast Combined Injury
2.1 Biochemical Effects
2.2 Hemodynamic Response
2.3 Physical Response to Projectile-Blast Combined Injury
3 Clinical Features of Projectile-Blast Combined Injuries
4 Diagnosis of Projectile-Blast Combined Injuries
4.1 Medical History
4.2 Symptoms and Signs
4.3 Hemogram and Biochemical Indicators
4.4 Special Examinations
5 Treatment of Projectile-Blast Combined Injuries
5.1 First Aid on Site
5.2 Management Principles of Projectile-Blast Combined Injury
5.3 Management of Special Injuries
Bibliography
Combined Radiation-Blast Injury
1 Conditions for Occurrence of Radiation Combined Blast Injuries
1.1 Occurrence of Radiation Combined Blast Injuries in Wartime
1.1.1 CRBI Through Nuclear Weapons
1.1.2 CRBI from Depleted Uranium Weapons
1.2 Occurrence of Radiation Combined Blast Injuries in Peacetime
1.2.1 Nuclear Terrorist Attack
1.2.2 Serious Nuclear Accidents
2 Classification and Condition of Radiation Combined Blast Injuries
2.1 Classification
2.2 Condition
3 Clinical Features and Pathological Basis of Combined Radiation-Blast Injuries
3.1 Overall Effect
3.1.1 Severity of Injuries Depends Largely on Radiation Dose
3.1.2 Course of Diseases has Radiation Sickness Characteristics
3.1.3 Mortality
3.1.4 Survival Time
3.1.5 Dose Effect
3.2 Cellular, Tissue, and Organ Effects
3.2.1 Bone Marrow
3.2.2 Small Intestine
3.2.3 Lungs
3.3 Combined Effects of Important Pathological and Physiological Processes
3.3.1 High Incidence of Shock
3.3.2 High Incidence, Early Onset, and Severity of Infection
3.3.3 Delayed Wound Healing
Weakened Inflammatory Response
Local Infection and Hemorrhage
Inhibition of Histiocyte Regeneration
Effects of Radioactive Substances on Wound Surfaces and Wounds
Other Factors
3.3.4 Aggravation of Hematopoietic Disorder
Changes in Leukocytes
Changes in Erythrocytes
Changes in Platelets
4 Diagnosis of Radiation Combined Blast Injuries
4.1 Early Classification Diagnosis
4.1.1 History of Injuries
4.1.2 Surroundings
4.1.3 Early Signs and Symptoms
4.1.4 Preliminary Estimation of Exposure Doses
4.1.5 Peripheral Hemogram Change
4.2 Clinical Diagnosis
4.2.1 Signs and Symptoms
4.2.2 Laboratory and Function Tests
5 Clinical Classification of Radiation Combined Blast Injuries
6 First Aid and Treatment of Radiation Combined Blast Injuries
6.1 Treatment Principles
6.2 First Aid on Site and Emergency Treatment
6.3 Early Treatment
6.4 Specific Treatment
6.5 Advances of Prophylactic-Therapeutic Research
6.5.1 Ciprofloxacin (CIPRO)
6.5.2 Ghrelin
6.5.3 Vitamin E Analogs
Bibliography
Toxin-Blast Composite Injury
1 Overview
2 Epidemiological Characteristics
3 Injuring Characteristics
4 Injury Mechanism
5 Clinical Manifestations
6 Rescue Strategies and Measures
Bibliography
Part V: Blast Injury in Special Environments
Plateau Blast Injury
1 Injuring Features of Plateau Blast Injury
1.1 Characteristics of Physical Parameters of Plateau Blast Injury
1.2 Target Organs of Plateau Blast Injury
1.3 Characteristics of Injury Conditions of Plateau Blast Injury
1.4 Reduction in the Body’s Tolerance of Blast Injury on Plateau
2 Clinical Features of Plateau Blast Injury
2.1 Clinical Manifestations of Blast Lung Injury
2.1.1 Main Pathological Changes in Blast Lung Injury
Pulmonary Hemorrhage
Pulmonary Edema
Lung Rupture
Pulmonary Bullae
Pulmonary Collapse and Emphysema
Acute Respiratory Distress Syndrome
Important Cellular Inflammatory Response
Apoptosis
2.1.2 Main Pathological and Physiological Changes in Blast Lung Injury
2.1.3 Clinical Manifestations of Blast Lung Injury
2.1.4 Complications of Blast Lung Injury
2.2 Clinical Features of Abdominal Blast Injuries
3 Treatment Principles for Plateau Blast Injury
3.1 Cautions in Treating Plateau Blast Injury
3.2 Treatment Methods for Plateau Blast Lung Injury
3.2.1 Life Support and Regular Symptomatic Treatment
3.2.2 Mechanical Ventilation
3.2.3 Extracorporeal Membrane Oxygenation (ECMO)
3.2.4 Hyperbaric Oxygen Therapy
3.2.5 Anisodamine and dexamethasone
3.3 Treatment of Plateau Blast Injury to Abdomen
3.4 Initial Surgical Treatment for Extremity Blast Injuries on Plateau in Peacetime
4 Features of Plateau Burn-Blast Combined Injury
4.1 Basic Features of Plateau Burn-Blast Combined Injury
4.2 Clinical Expressions of Burn-Blast Combined Injury
4.2.1 Clinical Expression of Burns
4.2.2 Clinical Manifestation of Blast Injuries
4.2.3 Features of Clinical Expressions of Burn-Blast Combined Injury
4.3 Comprehensive Judgment of Burn-Blast Combined Injury Condition
4.4 Treatment Principles for Burn-Blast Combined Injury
5 Features of Plateau Projectile-Blast Composite Injury
5.1 Injuring Features of Plateau Projectile-Blast Injury
5.2 Pathological and Physiological Features of Plateau Projectile-Blast Injury
5.2.1 Changes in Respiratory System After Plateau Projectile-Blast Injury
5.2.2 Rise in Endothelin After Injury from Hi-Speed Projectile
5.2.3 Impacts of Plateau Injury from Hi-Speed Projectile on Hemodynamics
5.2.4 Hypercoagulable State Instigated by Plateau Injury from Hi-Speed Projectile
5.2.5 Impacts of Plateau Injury from Hi-Speed Projectile on Inflammatory Response
5.2.6 Impacts of Plateau Injury from Hi-Speed Projectile on Metabolism
5.3 Features of Plateau Projectile-Blast Combined Injury
Bibliography
Underwater Blast Injury
1 Injuring Features of Underwater Blast Injury
1.1 Physical Properties of Underwater Shock Wave
1.1.1 Velocity of Propagation
1.1.2 Distance of Propagation
1.1.3 Mode and Energy of Propagation
1.1.4 Reflected Wave and Tensile Wave
1.1.5 Calculation of Pressure of Underwater Shock Wave
1.2 Relationships Between Injury Severities and Physical Parameters of Underwater Shock Wave
1.2.1 Information from Animal Testing
1.2.2 Information of Persons Injured
1.3 Injuring Features of Underwater Shock Wave
1.3.1 High Rate of Fatality
1.3.2 Large Fatal Range
1.3.3 Lungs Are the Main Target Organs
1.3.4 Much More Severe Damage to Abdomen than Air Blast Injury
1.3.5 Severe Injury to Air-filled Organs and Low Rate of Injury to Solid Organs and Liquid-filled Organs
1.3.6 Extremely Rare Surface Wounds and Multi-injuries
1.3.7 Rare Craniocerebral Injuries
2 Clinical Features of Underwater Blast Injury
2.1 Clinical Pathological Features of Underwater Blast Injury
2.1.1 Lung Injuries are Most Common
2.1.2 Abdominal Injuries Are Relatively Common and Severe
2.2 Typical Cases
3 Treatment Principles for Underwater Blast Injury
3.1 Diagnosis of Underwater Blast Injury
3.1.1 Injury Environment
3.1.2 Symptoms and Signs
3.1.3 Arterial Blood Gas Analysis
3.1.4 Exploratory Laparotomy
3.2 General Principles for Treatment of Underwater Blast Injury
3.3 Treatment Principles for Underwater Blast Injury to the Chest or Abdomen
3.3.1 Treatment Principles for Underwater Blast Injury to the Chest
3.3.2 Treatment Principles for Underwater Blast Injury to the Abdomen
4 Tiered Treatment for Underwater Blast Injury
5 Protection Against Underwater Blast Injury
Bibliography
Cabin Blast Injury
1 Overview
2 Types of High-Explosive Ammunitions Used to Strike Cabins
2.1 Explosive Ammunitions
2.1.1 High-Explosive Ammunition and High-Explosive Fragmentation Ammunition
2.1.2 High-Explosive Anti-tank Warhead
2.1.3 Enhanced Blast Warheads
2.1.4 Improvised Explosive Device
2.2 Kinetic Energy Ammunition
2.2.1 Armor-Piercing Shell
2.2.2 Deep Penetration Warhead
2.3 Composite Ammunition
3 The Influence of Cabin Structure on Blast Injuries
3.1 Level of Enclosure
3.1.1 Complex Shock Wave
3.1.2 Difficulties in Heat and Smoke Dissipation
3.2 Cabin Construction Material
3.2.1 Fragments of Cabin
3.2.2 Combustion
3.2.3 Derivative Shock Waves
3.2.4 Impact Shock, and Compressed Wave and Seismic Wave in Soil
4 Injuring Mechanisms
4.1 Primary Mechanism
4.1.1 Penetrating Effects
4.1.2 Blast Effects
4.1.3 Fragmentation Effects
4.1.4 Thermal Effects
4.2 Secondary Mechanisms
4.2.1 Secondary Fragmentation Effects
4.2.2 Cratering Effects
4.2.3 Secondary Blast or Ignition Effects
5 Features of Cabin Blast Injury
5.1 Severe Injuries and High Death Rate
5.2 Obvious Polarization of Injury Conditions
5.3 Complicated Injuries
5.4 High Occurrence Rate of Bone Fracture and Visceral Injury
5.5 Prominent Closed Injuries and High Rate of Traumatic Brain Injury
6 Treatment Principles and Techniques for Cabin Blast Injury
6.1 In-cabin Emergency Treatment
6.1.1 Searching
6.1.2 Emergency Treatment
6.2 Emergency Treatment Outside of Cabin
6.2.1 Injury Level Assessment
6.2.2 Open Up Airways
6.2.3 Maintain Respiration
6.2.4 Control Bleeding
6.2.5 Dressing
6.2.6 Fixation
6.2.7 Cardiopulmonary Resuscitation
6.2.8 Hemorrhagic Shock Fluid Resuscitation
6.2.9 Analgesia
6.2.10 Application of Prophylactic Antibiotics
6.2.11 Maintain Body Temperature
6.2.12 Outside Cabin First-Aid for Several Types of Cabin Blast Injuries
Blast Injuries
Burns and Inhalation Injuries
Crush Injuries
Combined Injuries
Impact Injuries
Eye Injuries
Traumatic Brain Injury (TBI)
6.3 Initial Surgical Resuscitation
6.3.1 Injury Condition Evaluation
6.3.2 Damage Control Surgery
6.3.3 Resuscitation and Rewarming
Fluid Resuscitation
Breathing Support
Rewarming
6.3.4 Emergency Surgery
6.3.5 Infection Prevention
6.3.6 Key Points of Initial Surgical Resuscitation for Several Types of Cabin Blast Injuries
Blast Injuries
Burns and Inhalation Injuries
Crush Injuries
Composite Injuries
Collision Injuries
Eye Injuries
Traumatic Brain Injury
Bibliography
Part VI: Different Types of Blast Injuries
Nuclear Blast Injury
1 Section One: Nuclear Weapons
1.1 Overview of Nuclear Weapons
1.2 Principles of Nuclear Weapons
1.2.1 Nucleus and Changes Within Nucleus
Nucleus
Mass, Conservation of Energy, and Nuclear Binding Energy
Mass Effect
Nuclear Potential
Law of Mass and Energy Connection
Binding Energy of Nucleus
Changes in the Nucleus
Nuclear Decay
Law of Radioactive Decay
Half-Life Time
Nuclear Reaction
Nuclear Fission
Nuclear Fusion
1.2.2 Explosion Principle and Basic Composition of Nuclear Weapons
Atomic Bomb
Explosion Principle
Basic Structure
Detonation Process
Hydrogen Bomb
Explosion Principle
Basic Structure
Detonation Process
Neutron Bomb
1.2.3 Explosion Methods and Explosion Visual Effects of Nuclear Weapons
Air Nuclear Burst
Ground (Water) Surface Nuclear Burst
Underground (Underwater) Burst
2 Section Two: Lethal Factors of Nuclear Weapons
2.1 Light Radiation
2.1.1 Formation of Light Radiation
2.1.2 Main Properties of Light Radiation
Release of Energy
Radiant Exposure
Propagation of Light Radiation
2.2 Shock Wave
2.2.1 Formation of Shock Wave
2.2.2 Main Properties of Shock Wave
Pressure of the Shock Wave
Propagation of Shock Wave
Effective Duration of Shock Wave
2.3 Initial Nuclear Radiation
2.3.1 Formation of Initial Nuclear Radiation
2.3.2 Main Properties of Initial Nuclear Radiation
High Propagation Velocity
Short Effective Duration
Scattering
Strong Penetration That May Be Weakened by Media
Generation of Induced Radioactivity
2.4 Radioactive Contamination
2.4.1 Formation of Radioactive Contamination
2.4.2 Main Properties of Radioactive Contamination
Composition
Physical and Chemical Properties
Pattern of Decay of Fallout
Radioactive Contamination Volume
3 Section Three: Lethal Factors of Nuclear Weapons
3.1 Injuring Effects of Four Main Lethal Factors
3.1.1 Injuring Effects of Light Radiation
Direction of Body Area Burned
Superficiality of Depth of Burns
High Occurrence Rate of Burns in Special Parts of the Body
Flash Blindness
3.1.2 Injuring Effects of Initial Nuclear Radiation
3.1.3 Injuring Effects of Radioactive Contamination
3.2 Injury Types and Severity Caused by Nuclear Weapons
3.2.1 Injury Types
3.2.2 Injury Severity
3.3 Range of Injury and Death of Nuclear Weapon
3.4 Main Factors Affecting Destructive Power of Nuclear Weapons
3.4.1 TNT Equivalent and Explosion Method of Nuclear Weapon
TNT Equivalent of Nuclear Weapon
Explosion Method of Nuclear Weapon
3.4.2 Population Density and State of Protection
3.4.3 Natural Conditions
Climate Conditions
Geography and Landform
4 Section Four: Occurrence of Nuclear Blast Injuries
4.1 Casualty Range of Nuclear Blast Injuries
4.2 Radii and Areas of Various Injury and Death Zones of Nuclear Blast Wave
4.3 Ratios of Different Injury Severity Levels in Different Injury and Death Zones of Nuclear Explosion
5 Section Five: Clinical Manifestations of Nuclear Blast Injury
5.1 Pattern of Nuclear Blast Injury Severity
5.1.1 High Number of and High Severity Level of Primary Blast Injuries
5.1.2 High Occurrence Rate of Secondary Blast Injuries
5.1.3 High Occurrence of Multiple Injuries and Multi-Part Injuries
5.1.4 Many Combined Injuries
6 Section Six: Treatment Principles for Nuclear Blast Injuries
Bibliography
Injuries from Conventional Explosive Weapons
1 Section One: Types of Conventional Explosive Weapons
1.1 Lethal and Blast Weapons
1.2 Anti-Armor and Anti-Structure Weapons
1.3 Thermobaric Weapons
1.4 Improvised Explosive Device
2 Section Two: Main Injuring Factors of Conventional Explosive Weapons and Their Injuring Mechanisms
2.1 Injury and Death Mechanisms of Fragments
2.1.1 Effects of Direct Tearing Injuries from Fragments
2.1.2 Effects of Hydrodynamics and Accelerated Particles
2.1.3 Transient Cavity Effect
2.1.4 Effects of Shock Wave
Kinetic Energy of Fragment
Stability of Fragment
Structural Features of Fragment
Features of the Injured Tissue
2.2 Combined Injuring Mechanism of Shock Wave
2.2.1 Composite Shock Wave-Heat Injuring Mechanism
Airway Obstruction
Decline in Lung Compliance
Rise in Lung Water Content
Pulmonary Ventilation/Blood Flow Imbalance and Increased Intrapulmonary Shunt
2.2.2 Composite Shock Wave-Hypoxia Injuring Mechanism
3 Section Three: Epidemiological Features of Normal Blast Injuries
3.1 Characteristics of Shock Wave of Conventional Explosive Weapons
3.2 Features of Blast Injuries of Conventional Explosive Weapons
4 Section Four: Evaluation of Injuries from Conventional Explosive Weapons
4.1 Evaluation Models for Injuries from Conventional Explosive Weapons
4.2 Criteria for the Assessment of Injuries from Explosive Weapon
4.2.1 Classification and Fundamental Basis of Severity of Biological Injuries (Table 1)
4.2.2 Assessment Methods for Severity of Fragmentation Injuries
4.2.3 Assessment Methods for Severity of Blast Injuries (Including Burns)
Lung Injury Grades
Throat, Windpipe Injury Grades
Abdominal Cavity Hollow Organ Injury Grades
Abdominal Cavity Solid Organ Injury Grades
4.2.4 Assessment for Composite and Overall Injury Severity
4.3 Computer Simulation Evaluation of Injuries from Explosive Weapons
4.3.1 Status Quo and Development
ComputerMan
Operational Requirement-Based Casualty Assessment Software System (ORCA)
4.3.2 Computer Simulation Method and Cases
Computer Analysis of Ballistic Injury
Method and Steps of Ballistic Injury Simulation Analysis Illustrated Via Handgun Penetrating Wound of the Lower Limb
Construction of Three Dimensional Anatomical Model and Finite Element Model of Lower Limbs
Construction of Projectile Digital Geometric Model and Finite Element Model
Calculation of Numerical Simulation of Lower Limb Penetrated by Bullet
Extraction and Statistical Processing of Calculation Results
Overall Evaluation of Injury Status
Computer Analysis of Blast Injury
Let Us Use a Human Chest Subjected to Complex Shock Wave with Overpressure of 100 kPa as Example to Illustrate the Method and Steps in Blast Injury Simulation Analysis
Construction of Digital Anatomical Model and Finite Element Model of Human Chest
Construction of Shock Wave Load Model
Numerical Solution of Shock Wave Loading on Human Body
Extraction and Statistical Processing of Calculation Results
Injury Status Evaluation
5 Section Five: Protection Against and Treatment of Injuries from Conventional Explosive Weapons
5.1 Protection Against Explosive Fragmentation Injuries
5.2 Protection Against Blast Injuries
5.2.1 Protection Through Simple Actions
5.2.2 Protection Through Landform
Infantry Personal Protective Equipment
Armored Chamber
Defensive Fortification
5.3 Principles for Treatment of Fragmentation Injuries
5.4 Principles of Treatment for Blast Injuries
5.4.1 Unexpectedness of Blast Injuries and Difficulty in Organizing Rescue Effort
5.4.2 Numerous Injury Effects and Complicated Injury Conditions
5.4.3 Severe Injury Conditions, Multiple Complications, and High Death Rate
5.4.4 Simultaneous Existence of Internal and External Injuries That Can Easily Lead to Missed or Erroneous Diagnosis
5.4.5 Severe Loss of Soft Tissue
5.4.6 Complicated Infections and Great Treatment Difficulties
5.4.7 High Rate of Destructive Limb Injuries, Severe Impact On and Difficulty in Repair of Limbs
5.4.8 Untimely Evacuation and Missing Best Opportunity for Treatment
5.4.9 Treatment Difficulties and Dilemmas
5.5 Principles of Treatment for Combined Injuries Caused by Explosive Weapons
Bibliography
Land Mine Blast Injury
1 Section One: Types of Land Mines
1.1 Antipersonnel Land Mine
1.2 Antitank Land Mine
1.3 Antiair Land Mine
1.4 Special Purpose Land Mine
2 Section Two: Land Mine Contamination
2.1 Distribution of Remaining Land Mines
2.2 Harms of Remaining Land Mines
2.2.1 Bodily Injury
2.2.2 Harms to Animals
2.2.3 Hindrance to Agriculture
2.2.4 Obstruction to Transportation
2.2.5 Increase of Social Burden
3 Section Three: Features of Land Mine Explosions
3.1 High Death Rate Before Arrival at Hospital
3.2 High Rate of Shock
3.3 High Rate of Limb Injury
3.4 Mop-Like Foot and Calf Injury
3.5 Severe Wound Contamination and High Rate of Infection
3.6 High Rate of Amputation
3.7 Neuroma After Amputation
3.8 High Rate of Multiple Injuries Affecting Multiple Body Parts
3.9 Serious Psychological Harm
4 Section Four: Injury Factors of Land Mine Explosions
4.1 Injury from Shock Wave
4.2 Fragmentation Injury
4.3 Heat Injury
5 Section Five: Treatment of Injuries from Explosions of Land Mines
5.1 Take Active Steps to Protect Against Shock
5.2 Carry Out Debridement Early and Delay Suture
5.3 Change of Medication for Wound
5.4 Treatment of Bone Fracture
5.5 Dealing with Serious Loss of Soft Tissues
5.6 Amputation
5.7 Rehabilitation After Amputation
References
Further Readings
Blast Injuries from Mining Gas
1 Section One: Overview
2 Section Two: Characteristics of Mining Gas Blast Injuries and Pathological and Physiological Changes in the Human Body
2.1 Characteristics of Mining Gas Blast Injuries
2.2 Burns and Inhalation Injuries from Mining Gas Explosion
3 Section Three: Clinical Manifestations and Treatments of Blast Injuries from Mining Gas
3.1 Clinical Manifestations
3.2 Treatment
3.2.1 On-Site Treatment
3.2.2 Hospitalized Treatment
Reception of Victim
Examination Upon Reception
Avoid Common Mistake During Patient Reception
Examinations of Injuries to Different Parts of the Body
External Wound History
Full-Body Check
Specialized Examinations
Supplemental Examinations
3.3 Injury Severity Scoring
3.3.1 Injury Severity Score: Abbreviated Injury Scale (AIS-ISS)
3.3.2 A Severity Characterization of Trauma (ASCOT)
Collection of Clinical Information
Numerical Model Calculation for PS Value
3.3.3 Mining Gas Blast Injury Bodywide Complication Diagnosis with Injury Severity Score, Abbreviated Injury Scale (AIS-ISS)
4 Section Four: Treatment of Mining Gas Blast Injuries in Hospital
4.1 Rectify Injury: Hemorrhagic Shock
4.1.1 Replenish Blood Volume
4.1.2 Stop Blood Loss
4.1.3 Relieve Pain
4.1.4 Administer Vasoactive Agent
4.1.5 Rectify Acidosis
4.1.6 Protect Cardiac, Pulmonary and Renal Functions
4.1.7 Protect Against Infection
4.1.8 Make Appropriate Use of Traditional Chinese Medicine
Etiological Mechanism
Sub-Divisions
Treatment
Emergency Treatment
Treatment Based on Syndrome Differentiation
Loss of Body Compositions
Syncope
Acupuncture Treatment
4.2 Treatment of CO Poisoning
4.3 Treatment of Injuries of Respiratory Tract
4.4 Treatment of Skin Burn
4.5 Treatment of Combined Injuries
5 Section Five: Establishment of Coal Mine Medical Emergency and Rescue System in China
5.1 Background of the Chinese Mining Industry
5.2 History and Status Quo of Mine Medical and Rescue System in China
5.3 Chinese National-Level Efforts in Building Mine Medical Assistance System
5.3.1 Development of Organization System
5.3.2 Development of Objective System
5.3.3 Development of Management System
Blast Injuries from Explosion of Chemicals
1 Section One: Chemicals and Hazardous Chemicals
1.1 Definition of Chemicals
1.2 Hazardous Types of Chemicals
1.2.1 Physical Hazards of Chemicals
1.2.2 Health Hazards
1.2.3 Environment Hazards
1.3 Hazardous Chemicals
1.3.1 Definition of Hazardous Chemical
1.3.2 List of Hazardous Chemicals
1.4 Other Relevant Flammable and Explosive Items in China
1.4.1 Explosives for Civil Use
1.4.2 Fireworks and Firecrackers
1.4.3 Easily Produced Explosive and Hazardous Chemicals
1.5 Categories of Common Explosive Chemicals
1.5.1 Categories of Explosives
1.5.2 Categories of Flammable Gases
1.5.3 Categories of Flammable Aerosols
1.5.4 Categories of Compressed Gases
1.5.5 Categories of Flammable Liquids
1.5.6 Categories of Flammable Solids
1.5.7 Categories of Self-Reacting Substances
1.5.8 Categories of Pyrophoric Liquids
1.5.9 Categories of Pyrophoric Solids
1.5.10 Categories of Self-Heating Substances
1.5.11 Categories of Substances That Release Flammable Gases in Contact with Water
1.5.12 Categories of Organic Peroxides
2 Section Two: Explosions in Industrial Activities
2.1 Explosions and Categories
2.1.1 Definition of Explosion
2.1.2 Categories of Explosions
Physical Explosion
Chemical Explosion
2.1.3 Destructive Effects of Explosion
2.2 Analysis of Common Factory Explosions
2.2.1 Explosion of Flammable Gas
Explosion of Decomposed Explosive Gas
Explosion of Flammable Gas Mixture
Explosion Limit
Evaluation of Consequence of Explosion
Empirical Models
Phenomenological Models
Computational Fluid Dynamics (CFD)
2.2.2 Explosion of Flammable Dust
2.2.3 Explosion of Explosives
Explosiveness
Sympathetic Detonation
2.2.4 Explosion Caused by Accumulation of Heat from Chemical Reaction
3 Section Three: Application of Blast Injury Principles
3.1 Recommended Overpressure Principle in Safety Evaluation
3.2 External Safety Distance Between Production Equipment and Storage Facilities of Hazardous Chemicals
3.3 External Distance in Engineering Design for Explosives for Civil Use, Fireworks and Firecrackers
3.4 Allowable Safety Distance in Blasting Works
3.4.1 Allowable Safety Distance Between Blasting Site and People or Other Subjects of Protection
Open-Air Ground Surface Blasting
Blasting Processing or Large-Equivalent Ground Surface Blasting
3.4.2 Storage Quantity and Distance for Blasting Equipment
Bibliography
Terrorist Blast Injuries
1 Section One: Trends in Changes in Terrorist Bombing
1.1 Diverse Motives of Terrorist Bombings
1.2 Expanded Areas of Terrorist Bombings
1.3 Spreading Targets of Terrorist Bombings
1.4 Networked Propaganda of Terrorist Organizations
1.5 Recruitment of Local Youth into Terrorism
1.6 Expansion of Terrorist Bombing Operations from “Al-Qaeda” to “Lone Wolf”
1.7 Diversified and Integrated Means of Attack
1.8 High-Tech Explosive Weapons
2 Section Two: Main Methods and Types of Terrorist Bombings
2.1 Bombing
2.2 Car Bomb
2.3 Suicide Bomb
2.4 Mail (Package) Bomb
2.5 Fixed Bag Bomb
2.6 Inflatable Boat Bomb
3 Section Three: Main Hazards of Terrorist Explosion
3.1 Threat to Public Safety
3.2 Impact on Domestic and International Political Landscape
3.3 Restriction to Social and Economic Development
3.4 Casualty
4 Section Four: Analysis of the Characteristics of Terrorist Explosion
4.1 Myriad Types of Bombs with High-Energy Explosives Becoming Dominant
4.2 Diversification, High-Tech Orientation and Intelligentization of Explosive Devices
4.3 Diverse Means That Are Sudden and Difficult to Guard Against
4.4 More Extensive Attack Targets and More Serious Damage
5 Section Five: Destruction Factors and Damage Types of Terrorist Bombing Injuries
5.1 Factors of Destruction and Destruction Caused by Terrorist Explosion
5.2 Main Types of Terrorist Explosion Injuries
5.2.1 Direct Impact Injury (Blast Injury)
Impact and Displacement by Dynamic Pressure
Rapid Squeezing Effect Directly Caused by Overpressure
Relatively Light Injuring Effects of Negative Pressure
5.2.2 Indirect Impact Injury
5.2.3 Fragment Injury
5.2.4 Burn
5.2.5 Other Injuries
5.3 Different Levels and Types of Terrorist Bombings
6 Section Six Main Features of Terrorist Bombing Injuries
6.1 Multiple Causes, Complicated Conditions and Serious Damage
6.2 Clear Direction
6.3 Sudden Occurrence with Many Wounded
6.4 Multiple Complications and Rapid Deterioration
6.5 Heavy Casualties with a High Rate of Mortality
6.6 Severe Psychological Trauma
7 Section Seven: Medical Aid of Injuries Caused by Terrorist Bombing
7.1 Rescue Principles
7.1.1 Safety First Principle
7.1.2 Joint Self-Rescue and Mutual Rescue Principle
7.1.3 Save Lives Before Treatment Principle
7.1.4 Unified Command Principle
7.1.5 Categorized Evacuation Principle
7.2 Organization of Medical Aid
7.2.1 Organization of On-Site First Aid
Basic Requirements
Main Tasks
The Search and Rescue of Victims Buried at the Scene of the Blast
The Medical Evacuation of Victims On-Site
7.2.2 Organization of Treatment in Hospital
Swiftly Initiate Prearranged Emergency Plan
Prepare Emergency Drugs and Medical Devices
Rapid Triage
Organize and Carry Out Effective Treatment
Earnestly Conduct Psychological Counseling for Victims and Their Families
Bibliography
Explosion Incidents
1 Section One: Terrorist Attack and Bombing
1.1 Typical Cases of Terrorist Bombing
1.2 Features of Injuries from Terrorist Bombing
2 Section Two: Explosion of Hazardous Chemicals
2.1 Typical Cases in Explosion of Hazardous Articles
2.1.1 Explosion from Improper Storage of Hazardous Articles
2.1.2 Explosion of Chemical Transport Pipeline
2.1.3 Explosion in Fireworks and Firecracker Production and Manufacturing
2.2 Features of Explosion Incidents of Hazardous Articles
3 Section Three: Explosion of Coal Mine Gas
3.1 Typical Cases of Coal Mine Gas Explosion
3.2 Features of Blast Injury from Coal Mine Gas Explosion
4 Section Four: Explosion of Dust
4.1 Typical Cases of Dust Explosion
4.2 Features of Blast Injury from Dust Explosion
5 Section Five: Explosion of Town Gas in Residential Area
5.1 Typical Cases of Natural Gas Explosion
5.2 Features of Blast Injury from Natural Gas Explosion
Bibliography
Index