What Do We Know About Blast Injuries Speculating About the Boston Marathon Bombing

Remains of a low order device

The Disease Management Care Blogs thoughts and prayers go out to the Boston Marathon bombing victims and their families. Like all Americans, it hopes the death rate remains low and is confident that the survivors recovery will be a credit to the world-class skill of the physicians and nurses staffing Bostons ERs, operating rooms and ICUs.

While it was digesting the horrific details, the DMCB was struck by the likelihood that the Afghan and Iraq wars as well as multiple terrorist attacks have enhanced our ability to deal with blast injuries.

What have we learned?

As outlined in this abstract, the initial explosion results in "primary" injury, fragment or shrapnel injuries are "secondary," being bodily thrown results in "tertiary" blunt injury while the burns and other trauma are "quaternary."  Its difficult to survive a primary injury because the supersonic compressive air wave travels though the human body and "shears" any organ with an air/water interface, such the lung and intestines; thats also why ear drums rupture.

According to the CDC, primary injuries are more likely with "high order" explosives such as military grade bombs or TNT.  "Low order" gun powder (the image above is from a "pipe" bomb) or petroleum-based devices are less likely to result in supersonic shock waves. That - and reports of "white smoke" - may account for the initially low mortality rate at the Marathon. Interestingly, body armour does not protect against a primary injury and a ruptured ear drum is a poor predictor of its presence.

Unfortunately, the stress wave can also cause bone fractures and, if severe enough, "transosseous" amputation.  The DMCB was dismayed by reports of some of the victims losing their limbs, which suggests the devices were large if "low-order" bombs.  Amputations were common in the 05 London terror bombings because the victims were in close proximity to the devices and the blast waves were at ground level.  Initial reports from Boston suggest the devices were placed in trash receptacles, which, if it turns out to be true, would fit the pattern.

If victims are in shock from bleeding, the DMCBs uneducated first impulse would be to correct the low blood pressure and give lots of intravenous fluids and blood.  It turns out that combat surgeons have discovered that kind of aggressive therapy can increase the rate of death and complications. The best current approach appears to be the use of "hypotensive resuscitation" and more liberal use of blood products (plasma, platelets and pack cells or whole blood) versus fluids. 

If you live in Boston and want to donate blood, you can check this out.

Given the standard emergency triaging, the DMCB suspects the secondary, tertiary and quaternary victim counts are still being compiled.  In addition, it will be some time before we understand the incidence of traumatic brain injuries and their associated symptoms of unbalance, hampered motor function, disordered vision, decreased communication and depression. The etiology and our ability to predict it remains a topic of research.

What Men Want Women to Know

Men Will Talk About Feelings

Was your guy raised as a traditional, stoic, mans man? If so, let me walk you through 18 relationship secrets, gathered from psychologists who study gender roles. Secret No. 1: It may be easier for your man to talk about feelings indirectly. Ask what hed do during a romantic weekend. Or what he thought the first time he met you. His answers will reveal how he feels and bring you closer.

Men Say "I Love You" With Actions

Some men per to express their feelings through actions rather than words. Your guy may say "I love you" by fixing things around the house, tidying up the yard, or even taking out the trash -- anything that makes your world a better place.

Men Take Commitment Seriously

Men have a reputation for being afraid to commit. But the evidence suggests men take marriage seriously. They may take longer to commit because they want to make sure they are onboard for good. In a survey of currently married men, 90% say they would marry the same woman again.

He Really Is Listening

When youre listening to someone talk, you probably pipe in with a "yes" or "I see" every now and then. Its your way of saying, "Im listening." But some guys dont do this. Just because a man isnt saying anything doesnt mean hes not listening. He may per to listen quietly and think about what youre saying.

Shared Activities Form Bonds

Men strengthen their relationships primarily through shared activities more than by sharing thoughts or feelings. For many men, activities like sports and sex make them feel closer to their partner.

Men Need Time for Themselves

While shared activities are important, men also need time for themselves. Whether your guy enjoys golf, gardening, or working out at the gym, encourage him to pursue his hobbies, while you make time for your own. When both partners have space to nurture their individuality, they have more to give to each other.

Men Learn From Their Fathers

If you want to know how a man will act in a relationship, get to know his dad. Some say men learn about their relationship role by watching and listening to their fathers. How they are with each other and how the father relates to the mother can predict how a man will relate to his wife.

Men Let Go Faster Than Women

Women tend to remember negative experiences longer and may have lingering feelings of stress, anxiety, or sadness. In contrast, men are less likely to dwell on unpleasant events and tend to move on more quickly. So while you may still want to talk about last nights argument, your guy may have already forgotten about it.

Men Dont Pick Up on Subtle Cues

Men are more likely to miss subtle signals like tone of voice or facial expressions. And they are especially likely to miss sadness on a womans face. If you want to make sure your guy gets the message, be direct.

Men Think About Sex ... A Lot

OK, so maybe this one is no secret. The majority of men under age 60 think about sex at least once a day, compared with only a quarter of women. And thats not all. Men fantasize about sex nearly twice as often as women do, and their fantasies are much more varied. They also think more about casual sex than women do. But thinking is not the same as doing.

Men Find Sex Significant

Its a myth that most men think sex is just sex. For many, sex is a very important act between two committed people. And just like most women, men find sexual intimacy to be most satisfying in the context of a committed relationship. One reason is that long-term partners know how to please one another better than strangers do.

He Likes It When You Initiate Sex

Most guys feel as though theyre the ones who always initiate sex. But they also like to be pursued and wish their partner would take the lead more often. Dont be shy about letting your guy know youre in the mood. Initiating sex some of the time may lead to a higher level of satisfaction for both of you.

Guys Arent Always Up for Sex

Men, much to many womens surprise, arent always in the mood for sex. Just like women, men are often stressed by the demands of work, family, and paying the bills. And stress is a big libido crusher. When a guy says, "not tonight," it doesnt mean hes lost interest in you. He just means he doesnt want to have sex right then.

Men Like Pleasing Their Partner

Your pleasure is important to your man. But he wont know what you want unless you tell him. Too many women feel uncomfortable talking about what they like and dont like. If you can tell him clearly in a way that doesnt bruise his ego, hell listen. Because he knows hell feel good if you feel good.

Guys Get Performance Anxiety

Most men get performance anxiety on occasion, especially as they age. Your guy may worry about his physique, technique, and stamina. If you can help him learn to relax and stay focused on the pleasures of the moment, sex will become less stressful.

Men May Stray When Needs Arent Met

If a man doesnt feel loved and appreciated in his relationship, he may turn elsewhere for satisfaction. For one man, that may mean burying himself in work. Another may develop a fixation on sports or video games. And some men cheat. To avoid this, partners need to work together to meet each others needs.

Hes Vested in You

Most men realize theres a lot to lose if a long-term relationship goes sour – not just each others company, but the entire life youve built together. If youre willing to work to strengthen your marriage, chances are your man will be, too.

Stay Humble We Dont Know What We Dont Know

Ive used this pic before. I dont care.

Id like to share a story with you. The other day in one of my classes, we were discussing the history of vitamin D. My professor told us a fascinating story about the early research on vitamin D and rickets, the bone disease children get as a result of a deficiency. This particular researcher, Leonard Findlay, had performed experiments with dogs, and he was convinced that rickets could be cured simply by exercising. In 1908, he published a paper detailing his experiments: "The Etiology of Rickets: A Clinical and Experimental Study".

What Findlay did, essentially, was induce rickets in dogs by keeping them sedentary. He would keep them locked up indoors in cages, providing them food of course, until they would develop symptoms of rickets. Then, as an experimental treatment, he would take some of the dogs outside and let them run around. Allowing the dogs to run around outside cured their rickets, and so Findlay assumed that exercise was the reason why.


Today we know that rickets is caused by a lack of vitamin D. As you may know, we can get vitamin D from simple sun exposure. It wasnt the exercise that cured Findlays dogs; it was the sun. But put yourself in Findlays shoes for a moment... if you didnt know that we could make vitamin D from the sun, how would you ever even identify that as a factor in your experiment? You wouldnt... because we just dont know what we dont know. Based on what we knew at that time, his experiment was air tight.

In hindsight, the idea that exercise cures rickets is absurd. But think about it in the context of the future... well likely be saying the same thing 100 years from now about what we believe to be true today. In any experiment, the goal is to control for the desired variable as best we can, so that we can be sure the results are due to that one variable and no other. We try to do this, or course. But in reality, theres no way to know what we dont know, and we cant control for that. 

Take an example. Say were testing the effectiveness of a gluten-free diet on symptoms of irritable bowel syndrome (IBS). So we recruit people with IBS, put half of them on a gluten-free diet, and keep the other half on their normal diet. We make sure both eat the same amount of calories, carbs, fat, and protein. The only difference appears to be the presence of gluten, but is it really? What dont we know? Well, for starters, we dont know much at all about the gut. Im talking about the microorganisms that live there, what their roles are in our health, and how food might impact it. We also cant quantify the impact of stress... what if its extremely stressful for someone to give up gluten? How does that impact things? We know very little of the compounds in food... take a carrot for example. We know of dozens and dozens of compounds within a carrot, and there are likely dozens more that are unidentified. On top of that, we really only know the biological function of a select few of them! What else dont we know? We just dont know! As you can see, nothing can be 100% controlled for, and nothing is really known for sure.

What will we know in 100 years? Maybe itll be common knowledge that air conditioning gives us cancer!! Doubt it, but who knows!?

My point is this: we should always keep an open mind. We should always remember to stay humble and understand that we dont know it all. Theres no telling how things could change in the future!

On another note though, there are certain things we CAN take to the bank... like eating whole foods. Doing what humans have always done, and have been successful doing, is always a safe bet! 

Know the Causes of Breast Cancer

Know the Causes of Breast Cancer | Most breast cancers in women over the age of fifty years. Data from the World Health Organization says that as many as seventy-eight percent of women who had been fifty years old suffer from this cancer.

For more information about breast cancer, lets go to Breast Cancer categories. Prevent breast cancer in women, Breast cancer in man, Avoid breast cancer by diet, Cause of breast cancer, What is Breast Cancer, Breast Cancer Preventing, 10 Foods that Fight Breast Cancer, Characteristics of a Healthy Breast, Beware Hard Lump in Breast, 7 ways to maintaining breast health

But that does not mean the young women who have not reached the age of fifty years of becoming aware of a cancer on this one. Therefore, the necessary attitude of vigilant and try to prevent breast cancer in a way to know what causes breast cancer.

Causes of Breast Cancer

In general, health experts could not determine the cause of breast cancer. However, there are several factors that can trigger cancer, among others:

1. Using the hormone estrogen to the usual therapy at menopause. The hormone estrogen serves as a drug to reduce symptoms of menopause. In addition, the use of these hormones can also to prevent bone disease or osteoporosis. However, behind some of the benefits of this hormone was also able to trigger the onset of breast cancer.

2. Taking birth control pills.
Contraceptive use in the form of birth control pills for long periods of time may increase the risk of breast cancer.

3. Obesity, especially during menopause.

4. Did not have children or pregnant in old age.
Pregnancy can reduce the risk of breast cancer, because the occurrence of pregnancy can reduce the overall number of menstrual cycles in women during his lifetime. However, the pregnant womans first child at the age of thirty has breast cancer risk greater than in women who become pregnant at a young age.

5. Never breastfed a child, is also a risk factor for breast cancer. Breastfeeding within a period of at least one to two years can reduce breast cancer risk.

6. Smoking and drinking alcoholic beverages is clearly not good for health. These bad habits are also at risk for breast cancer.

7. Less physical activity or exercise. Exercise to stay fit. By walking for at least ten hours a week can reduce the risk of breast cancer.

8. Do not pay attention to balanced nutrition in foods, such as eating too much fat and eat less fiber also trigger the onset of breast cancer.

9. The body can not build a good defense system

10. Heredity or genetics

Resource: Anneahira.com