Blast-related lung injuries

Blast-related lung injuries are occurring with increased frequency in a variety of circumstances, necessitating that both civilian and military providers across the healthcare spectrum understand how to promptly diagnose and manage these injury patterns. Primary, secondary, and tertiary blast injury mechanisms are most commonly encountered and can result in primary blast lung injury, air embolism, pulmonary contusion, rib fractures, and penetrating lung injuries. Primary blast lung injury occurs when a blast wave injures the lung parenchyma and vasculature and presents as acute dyspnea, cough, and hypoxemia with airspace disease on chest imaging. The treatment of primary blast lung injury, as well as other blast-related lung injuries, involves maintaining oxygenation and using a lung-protective strategy with low tidal volumes and minimal PEEP for patients requiring mechanical ventilation. Pain management, preferably in the form of regional anesthesia, is also crucial in improving outcomes in patients with blast-related lung injury.