Structural collapse can cause crush injuries and compartment syndrome. The strength of the explosion typically determines the severity of the tertiary injuries sustained. Victims may experience blunt or penetrating trauma depending on what object is struck. Tertiary injuries occur when the victim is propelled through the air by the blast wind and strikes another object, and/or when a structure collapses as the result of the explosion. Secondary injuries are the most common cause of mortality in patients exposed to blast injury. Seemingly small entrance wounds may hide devastating internal injuries. Explosive debris can travel faster than a bullet. Any part of the body can be subject to a secondary injury, though the head, neck, and extremities are the most common sites of injury. Secondary injuries are the most common type of blast injury and can include fractures, amputations, dislocations, lacerations, or any type of soft tissue injury. Bombmakers detonating explosives to cause harm to other humans may pack devices with objects such as nails or screws with the intent to injury as many people as possible. Such debris can be part of the surrounding environment or may be a part of the explosive device itself. Secondary blast injuries occur when debris propelled by explosive forces comes into contact with a victim. Blast lung is the most common lethal injury among patients surviving the initial period post exposure. Of note, blast belly and blast lung may not initially be obvious on exam patients can experience delayed presentations of up to 48 hours with either injury.
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