Episode
PFC Podcast 282: Blast Lung - Expert Tactics for Blast Lung Injury in Prolonged Field Care
- Podcast
- Prolonged Field Care Podcast
- Published
- Jun 8, 2026
- Duration seconds
- 3950
- Processing state
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Summary
In this high-signal PFC Podcast episode, Dennis sits down with Dr. John Wightman — former 24th Special Operations Wing Surgeon, emergency physician, and one of the world’s leading experts on blast injuries. Drawing from decades of clinical, combat, and academic experience (including co-authoring a seminal paper on blast injuries just before 9/11 and multiple combat deployments), Dr. Wightman breaks down the unique pathophysiology, recognition, and prolonged field care management of blast lung injury — the often-hidden threat that can kill even when penetrating trauma doesn’t. From the physics of the supersonic pressure wave to practical field decisions on tension pneumothorax, ventilation strategies, fluid management, and avoiding air embolism, this is essential listening for medics, operators, and anyone preparing for large-scale combat operations, urban warfare, or confined-space blasts. Key Takeaways: Primary blast lung injury is caused by the blast wave itself — not fragments or being thrown — and creates unique pulmonary contusions, air leaks, and arterial air emboli risks. Most significant blast lung develops within the first 1–6 hours; subtle dyspnea on exertion can be an early warning. MARCH priorities still rule — aggressively rule out (or treat) tension pneumothorax, even bilaterally, before assuming blast lung. Positive pressure ventilation can worsen outcomes (especially air embolism risk) — use judiciously; CPAP or PEEP may be better bridges when possible. PAO₂/FiO₂ ratio (or SpO₂ on room air) helps stratify severity and predict need for advanced support. Tympanic membrane rupture proves blast exposure but is not required for blast lung. Fluid management must be careful — permissive hypotension may be dangerous in blast lung + shock. Don’t forget occult bl…