According to the latest experimental results, the extent and types of primary blast-induced injuries depend not only on the peak of the overpressure but on other characteristics, such as the number of overpressure peaks, the lag between overpressure peaks, the shear fronts between overpressure peaks, frequency resonance, and electromagnetic pulse.

Previously, exposure to blast overpressure was considered to damage primarily gas-containing organs or those containing structures of different specific weights (such as ears, lungs, and the gastrointestinal tract) (Benzinger, 1950; Clemedson, 1956; Phillips and Zajtchuk, 1989). Therefore, most research focused on the mechanisms of blast injuries within gas-containing organs or organ systems, primary BINT was underestimated, and safety recommendations (Table 2.1) focused on the injurious effects of blast on extracerebral body parts and organs and not on hidden brain damage and potential neurologic consequences.

TABLE 2.3 Summary of Most Important Body-System Injuries Induced by Concomitant Primary, Secondary, Tertiary, and Quaternary Effects of Blast


Injury or Pathologic Condition

Auditory system

Eardrum rupture

Disruption of ossicles

Cochlear damage

Respiratory system

Blast lunga



Pulmonary contusion

Pulmonary hemorrhage

Airway epithelial damage

Aspiration pneumonitis


Arteriovenous fistula (air embolism)

Gastrointestinal system

Bowel perforation

Hemorrhage, fracture, rupture of liver or spleen

Mesenteric ischemia caused by air embolism


Nervous systemb


Closed (blunt) brain injury

Open (penetrating) brain injury

Stroke from air embolism

Spinal-cord injury

Cardiovascular system

Myocardial contusion

Myocardial infarction from air embolism

Cardiogenic shock

Peripheral vascular injury

Peripheral ischemia from air embolism


Genitourinary system

Renal contusion

Renal laceration

Acute renal failure due to shock or rhabdomyolysis

Testicular rupture

Visual systemc

Perforated eye globe

Foreign bodies in eye

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