Blast injury of the chest. A review of the problem and its treatment.

Primary blast injury of the chest is a potentially lethal entity. Immersion blast is even more damaging than that incurred out of water. Illustrative cases of a group of patients injured by an underwater explosion are presented. The pathogenesis, clinical manifestations and diagnosis of the entity are described. Complications include arterial occlusion by air emboli, affecting the central nervous system and heart, and respiratory insufficiency and failure. Conventional management of respiratory failure with intermittent positive pressure breathing may further aggravate the air embolism. An attempt to circumvent this conflict with the aid of the membrane oxygenator and hyperbaric facilities is discussed. It is suggested that expeditious compression with oxygen in a one-man chamber might be the most favorable emergency measure, to be followed later by more extensive and definitive treatment in a major hospital equipped for such contingencies.