It creates complex blast wave which contains blast pressure wave and mass movement of air. This explosion pressure wave is more than 1000 pounds per square inch. This pressure wave has got incident pressure and refl ected pressure. Both will cause severe damage

 Management of shock and triage primary manage-ment.

 Urgent surgeries like laparotomy, thoracotomy, craniotomy.

Individual becomes deaf after blast and so rescue work may be delayed.

The extent and pattern of injuries are a direct result of several factors,

• the amount and composition of the explosive material (eg, the presence of shrapnel or loose material that can be propelled; radiologic or biological contamination),
• the surrounding environment (eg, the presence of intervening protective barriers),
• the distance between the victim and the blast,
• the delivery method if a bomb is involved,
• and any other environmental hazards.
  No events are identical, and the spectrum and extent of injuries produced vary widely. [1]

Blast injuries are generally categorized as primary to quinary.

• Primary injuries (PBIs) are caused by the effect of transmitted blast waves on gas-containing structures;
• secondary injuries, by the impact of airborne debris;
• tertiary injury, by the transposition of the entire body because of blast wind or structural collapse;
• quaternary injuries, by exposure to explosive products (heat and light) or toxic substances;
• and quinary injury, by exposure to environmental contaminants, including chemicals, radiation, viruses, and bacteria

Systemic air embolism, most commonly occludes bl. vessels in the brain or spinal cord

Free radical–associated injuries as thrombosis, lipoxygenation, and DIC

Impaired pulmonary performance lasting hours to days

ARDS may be a result of direct lung injury or of shock from other body injuries

Tympanic membrane rupture (most common)

Ossicle fracture or dislocation may occur with very high energy explosions

A decrease in heart rate, stroke volume, and cardiac index

The normal reflex increase in systemic vascular resistance does not occur, so blood pressure falls

If this response is not fatal, recovery usually occurs within 15 minutes to 3 hours

Crush syndrome and acute renal failure may occur in patients rescued from collapsed structures. Increasing extremity pain after an explosion should raise the suspicion of compartment syndrome.

Most patients injured by significant explosions should have a screening urinalysis

If the explosion occurred in an enclosed space or was accompanied by fire, test carboxyhemoglobin (HbCO) and electrolytes to assess acid/base status

Pulse oximetry readings may be misleading in cases of CO poisoning

Victims of major trauma should have baseline hemoglobin determinations, crossmatching for potential blood transfusion, and screening for DIC

Do not overwhelm the laboratory with screening or protocol laboratory tests of little clinical benefit

Focused abdominal sonography for trauma (FAST) is a potentially useful tool for rapidly screening patients, especially in the setting of multiple seriously injured victims. A positive FAST examination in an unstable patient is an indication for surgical exploration of the abdomen in the operating room. A negative FAST examination is unreliable in the setting of penetrating trauma to the abdomen, flank, buttocks, or back, and it should be followed up with CT examination of the abdomen and pelvis.

• Abd. CT

a complex type of physical trauma resulting from direct or indirect exposure to an explosion. Blast injuries range from internal organ injuries, including lung and traumatic brain injury (TBI), to extremity injuries, burns, hearing, and vision injuries.