Neurological System

The mechanism behind severe head injury following explosion is usually that of secondary and tertiary blast injuries.

However, exposure to blast forces may result in primary blast injury to the brain and the degree of injury ranges from concussion through mild traumatic brain injury to diffuse axonal injury [12].

At higher over-pressures, skull fractures can occur and these, when occurring as a primary blast injury, are closely associated with blast lung injury [12].

Focal neurological deficit may be the result of systemic air embolism to the brain or spinal cord.


Management in the ED follows usual practice, with induction of anaesthesia and initiation of mechanical ventilation in unconscious patients.

Results of CT scanning will depend on the mechanism of injury. There are a significant number of radiology negative concussive injuries following blast injury [8].

Monitoring of intracranial pressures may be undertaken by the neurosurgical team and patients should be discharged to specialist neurological critical care units [12].

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