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Pathophysiology of primary blast injury
  1. Jason E Smith1 and
  2. J Garner2
  1. 1 Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  2. 2 Department of General Surgery, The Rotherham NHS Foundation Trust and Major Trauma Consultant, Sheffield Major Trauma Centre, Sheffield, UK
  1. Correspondence to Jason E Smith, Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham B15 2SQ, UK; jasonesmith{at}


The majority of patients injured in the recent conflicts in Iraq and Afghanistan were as a result of explosion, and terrorist incidents have brought blast injuries to the front door of many civilian hospitals that had not previously encountered such devastation. This article reviews the physics and pathophysiology of blast injury with particular relevance to the presentation and management of primary blast injury, which is the mechanism least familiar to most clinicians and which may cause devastating injury without externals signs.

  • blast injuries
  • explosions
  • trauma
  • blast lung injury

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  • Contributors JES wrote the initial draft. JG revised the manuscript. Both authors have approved the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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