Treatment in the ED

Treatment for blast lung in the ED should take into consideration the following:


All patients will require supplemental high-flow oxygen [12].

Large-bore tube thoracostomy is required for decompression of haemopneumothoraces [4].

Intubation and ventilation

although avoidance of positive pressure ventilation wherever possible is advocated to protect against systemic air embolism [5,9], it is not unusual for patients with blast lung to require intubation and mechanical ventilation for management of respiratory failure.

In order to limit the risk of systemic air embolism and pneumothorax, limited peak inspiratory pressures and positive end-expiratory pressures should be used.

Permissive hypercapnia may be necessary to enable limited-pressure ventilation and has not been found to increase morbidity, despite a relative respiratory acidosis [13].

Steroids are not indicated [12].

Learning Bite

Intubation and ventilation should not be withheld in hypoxic patients with blast lung, but should be initiated with caution.

Pulmonary oedema

Patients with blast lung are at high risk of pulmonary oedema due to increased capillary permeability.

Careful fluid resuscitation should be aimed at restoring perfusion of vital organs [5].

Invasive monitoring may be necessary to guide fluid management [7].

Systemic air embolism

Any patient thought to be suffering from systemic air embolism should, in the first instance, be treated with high-flow supplemental oxygen.

The gold standard therapy is hyperbaric oxygen, although in the polytrauma patient this is often not appropriate and will be inaccessible for many EDs [1].