| American Civilian Contractors in Iraq Traumatic Brain Injury The Signature Wound of the Iraq and Afghanistan Wars The symptoms of mild traumatic brain injury and post traumatic stress disorder can be identical and you may have both. Auditory system injuries and concussions are easily overlooked. |
| Explosions and Blast Injuries CLASSIFICATION OF EXPLOSIVES Explosives are categorized as high-order explosives (HE) or low-order explosives (LE). High-order explosives produce a defining supersonic over-pressurization shock wave. Examples of HE include TNT, C-4, Semtex, nitroglycerin, dynamite, and ammonium nitrate fuel oil (ANFO). Low-order explosives create a subsonic explosion and that does not produce over-pressurization. Examples of LE include pipe bombs, gunpowder, and most purely petroleum-based bombs such as Molotov cocktails or aircraft improvised as guided missiles. High-order and low- order explosives cause different injury patterns. Explosive and incendiary (fire) bombs are further characterized based on their source. Manufactured implies standard military-issued, mass-produced, and quality-tested weapons. Improvised describes weapons produced in small quantities, or the use of a device outside its intended purpose, such as converting a commercial aircraft into a guided missile. Manufactured (military) explosive weapons are exclusively HE-based. Terrorists will use whatever is available—illegally obtained manufactured weapons or improvised explosive devices (IEDs) that may be composed of HE, LE, or both. Manufactured and improvised bombs cause markedly different injuries. BLAST INJURIES Mechanisms of Injuries The four basic mechanisms of blast injury are termed as primary, secondary, tertiary, and quaternary (Table 1). An example that causes primary injury is blast wave, which refers to the intense over- pressurization impulse created by a detonated HE. Blast injuries are characterized by anatomic and physiologic changes that occur when the direct or reflective over-pressurization force impacts the body's surface. The HE blast wave (over-pressure component) should be distinguished from blast wind (forced superheated air flow). Blast wind may be encountered with both HE and LE. Low-order explosives are classified differently because they lack the defining over-pressurization wave of HEs. Low-order explosives cause injury from ballistics (fragmentation), blast wind (not blast wave), and thermal. There is some overlap between LE descriptive mechanisms and HE's secondary, tertiary, and quaternary mechanisms. Up to 10% of all blast survivors have significant eye injuries, generally due to perforations from high-velocity projectiles. They can occur with minimal initial discomfort, and present for care days, weeks, or months after the event. Symptoms include eye pain or irritation, foreign body sensation, altered vision, periorbital swelling, or contusions. Findings can include decreased visual acuity, hyphema, globe perforation, subconjunctival hemorrhage, foreign body, or lid lacerations. Liberal referral for ophthalmologic screening is encouraged. BRAIN INJURY Primary blast waves can cause concussions or mild traumatic brain injury (TBI) without a direct blow to the head. Consider the proximity of the victim to the blast, particularly when the patient complains of headache, fatigue, poor concentration, lethargy, depression, anxiety, insomnia, or other constitutional symptoms. The symptoms of concussion and post traumatic stress disorder can be similar. The signs and symptoms of a TBI can be subtle. Symptoms of a TBI may not appear until days or weeks following the injury or may even be missed when patients appear fine, even though they may act or feel differently (CDC, 2005b). Diagnosing a TBI is challenging because symptoms are often common to other medical conditions and the severity of the symptoms can change over time. Any patient may have a TBI who has a history of head trauma or who is suffering from confusion, disorientation, amnesia of events around the time of injury, loss of consciousness of 30 minutes or less, neurologic or neuropsychological problems, or who has a Glasgow Coma Scale (GCS) score of 13 or higher. Taking a careful medical history can be key to detecting a TBI. Any unusual or unexplained signs or symptoms should be evaluated further (CDC, 2005b). Auditory system injuries and concussions are easily overlooked. The symptoms of mild traumatic brain injury and post traumatic stress disorder can be identical. DVBIC In the war in Iraq and Afghanistan, improvised explosive devices create blast injuries, which are the most common cause of TBI in the theater of combat. Mild and moderate TBI’s are more prevalent in this conflict due to the vast improvement in protective gear worn by our service members. Blast injuries can result in the full spectrum of closed and penetrating TBIs (mild, moderate, and severe). The mild to moderate blast related TBI’s are often over looked in the presence of more severe polytrauma. Blast injuries are defined by four potential mechanism dynamics: Primary Blast: Atmospheric over-pressure followed by under-pressure or vacuum. Secondary Blast: Objects placed in motion by the blast hitting the service member. Tertiary Blast: Service member being placed in motion by the blast. Quaternary Blast: Other injuries from the blast such as burns, crush injuries, toxic fumes. |
Traumatic Brain Injury in the Context of War Of the patients who required medical evacuation from theater (war zone) to Walter Reed Army Medical Center (WRAMC), 32% had TBI.1 Of these patients, severe and penetrating TBI comprised only 8% of the total number of TBI patients. Although MRI is more sensitive for the detection of diffuse axonal injury, roughly 80% of SMs seen at the WRAMC are ineligible for MRI procedures because of the presence of metal fragments in their bodies. |
| If you were injured in or near a blast do not presume that you were screened for traumatic brain injury Only the most obvious cases were acknowledged by military medical until recently. DoD Avoided Brain Injury Screening AIG and CNA WILL NOT authorize screening for TBI CNA just denied TBI screening to a survivor of a cluster bomb that went off right at his feet. He was blown up, down, and apart but "suspected" TBI does not qualify until it is medically proven. This story in Salon "I am under a lot of pressure to not diagnose PTSD" includes this quote McNinch added that he also received pressure not to properly diagnose traumatic brain injury, Sgt. X's other medical problem. "When I got there I was told I was overdiagnosing brain injuries and now everybody is finding out that, yes, there are brain injuries," he recalled. McNinch said he argued, "'What are we going to do about treatment?' And they said, 'Oh, we are just counting people. We don't plan on treating them.'" McNinch replied, "'You are bringing a generation of brain-damaged individuals back here. You have got to get a game plan together for this public health crisis.'" |
| Comments from the Brain Injury Association of America on RIN 2900-AM75-“Schedule for Rating Disabilities; Evaluation of Residuals of Traumatic Brain Injury (TBI).” click here Better brain trauma testing called for in Iraq Brain Injured troops face unclear long term risks New IOM Report Predicts Long-Term Health Problems, Including Neurological Disorders Traumatic Brain Injury and Suicide Report to Congress Urges Accelerated Efforts to Create Breakthroughs on Traumatic Brain Injury Brain Trauma in Iraq Thousands of U.S. soldiers have survived powerful explosions in Iraq. Many are returning home with brain injuries that could result in long-term disabilities. Invisible Wounds of War Veterans suffering from Brain Injuries often have accompanying impairments The Delicate Brain |
Post Traumatic Brain Injury
Hormonal Deficiency Syndrome
Sleep Apnea caused by TBI
Hormonal Deficiency Syndrome
Sleep Apnea caused by TBI
| T Christian Miller of ProPublica and Daniel Zwerdling, NPR Brain Injury Full Coverage |
