Phillips Y Y
Ann Emerg Med. 1986 Dec;15(12):1446-50. doi: 10.1016/s0196-0644(86)80940-4.
Injury from explosion may be due to the direct cussive effect of the blast wave (primary), being struck by material propelled by the blast (secondary), to whole-body displacement and impact (tertiary), or to miscellaneous effects from burns, toxic acids, and so on. Severe primary blast injury is most likely to be seen in military operations but can occur in civilian industrial accidents or terrorist actions. Damage is seen almost exclusively in air-containing organs--the lungs, the gastrointestinal tract, and the auditory system. Pulmonary injury is characterized by pneumothorax, parenchymal hemorrhage, and alveolar rupture. The last is responsible for the arterial air embolism that is the principle cause of early mortality. Treatment for blast injury is similar to that for blunt trauma. The sequalae of air embolization to the cerebral or coronary circulation may be altered by immediate hyperbaric therapy. Use of positive pressure ventilatory systems should be closely monitored as they may increase the risk of air embolism in pneumothorax. Morbidity and mortality may be increased by strenuous exertion after injury and by the wearing of a cloth ballistic vest at the time of the blast.
爆炸造成的伤害可能源于爆炸冲击波的直接冲击作用（原发性）、被爆炸推动的物体撞击（继发性）、全身移位和碰撞（三次性），或来自烧伤、有毒酸类等的各种影响。严重的原发性爆炸伤最有可能出现在军事行动中，但也可能发生在民用工业事故或恐怖袭击中。损伤几乎只出现在含气器官——肺、胃肠道和听觉系统。肺损伤的特征是气胸、实质出血和肺泡破裂。后者是动脉空气栓塞的原因，而动脉空气栓塞是早期死亡的主要原因。爆炸伤的治疗与钝性创伤的治疗相似。立即进行高压治疗可能会改变空气栓塞到脑循环或冠状动脉循环的后遗症。使用正压通气系统时应密切监测，因为它们可能会增加气胸时空气栓塞的风险。受伤后剧烈运动以及爆炸发生时穿着布质防弹背心可能会增加发病率和死亡率。
