State of the Science: Blast Injury Pathophysiology

Blast injuries are particularly complex, because blast effects are multimodal, with injury-causing overpressure, dynamic pressure, debris, and fragmentation. The organs most vulnerable to blast injury are those which are gas-containing, such as the ears and lungs. Improvements to personal protective gear have improved the likelihood of surviving a blast event, but at the cost of sustaining significant, multisystem injuries. This chapter reviews the state of the science in terms of our understanding of the effects of blast on major physiological systems: auditory, respiratory, digesting, vascular, and neurological. A significant emphasis is placed upon the effects of blast on the neurological system, where the most significant advances have been made over the last 15–18 years and where the most significant advances are still needed.