ABSTRACT
Ballistic and blast injuries generally result in hemorrhage combined with tissue injury. Blast injuries are classified according to the forces causing injury. The reflex cardiovascular responses to hemorrhage and nociception (due to tissue damage) can interact and accentuate shock in some organs. The cardiovascular response to hemorrhage is also modified by blast injury and can be confounded by burns and the response to resuscitation. In trauma, shock (tissue oxygen delivery failing to meet demand) can be due to inadequate blood flow and/or oxygen content at the systemic or organ level. At the microvascular level shock can arise due to regional deficiencies in oxygen delivery and/or diffusion limitation of oxygen delivery to cells. Inflammation is associated directly with traumatic tissue injury and as a secondary injury arising from shock, with implications for morbidity and mortality. The interplay between cardiovascular control mechanisms, inflammatory and coagulation systems is complex, with each affecting the other, and is further complicated by therapeutic interventions. Finally, the response of the central nervous system (CNS) to blast exposure has received a lot of attention. CNS injury can be also associated with altered responses to haemorrhage, coagulopathy, and inflammatory responses.
