In addition to the concussive and burn effects of a bomb blast, injuries are caused by propelled bomb fragments. These projectiles produce tissue damage in much the same manner as bullets, but in a much less structured fashion. The fragments are not aerodynamically sound, resulting in unpredictable flight patterns. Unlike bullets, tumble and yaw are prominent in bomb shrapnel. The surface area of the shrapnel striking the human body will vary depending on its position at the time of contact and the size of the fragment. Composition of the bomb casing (e.g. steel, plastic) will dictate the degree of deformation and fragmentation that the shrapnel undergoes upon contact with tissue. Lead fragments will deform much more easily than steel, and plastic will deform in yet another fashion. The size of the temporary and permanent cavities and the amount of kinetic energy transferred will differ not only by these variables but also by the distance between the victim and the bomb. Since these fragments are not aerodynamically designed, their velocity will dissipate more quickly than that of bullets. All these elements usually prevent fragments from penetrating deep into tissues. Fragmenting antipersonnel weapons release a large number of fragments, usually of small size (200-500 mg). The small fragment size and low velocity results in a kinetic energy of only 25 to 30 J. A small temporary cavity is produced, skin damage is limited, and necrotic tissue within missile tracks is nominal, allowing for spontaneous healing without surgical intervention in most cases ( B.o.w.y.eLeLa! 1996). The degree of injury is related to the size of the explosive device, the distance between the device and the victim, and the surrounding medium (air or water). When combined with even a remote penetrating injury, the lungs seem to be the most susceptible to damage, presumably because of substances released from the necrotic wound track ( Huang ef a/ 1996).

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Sleep Apnea

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