Thermoacoustic blast can also cause a significant blunt trauma and associated fall injuries. The molecular physics of the process is not completely understood, but in effect, the strong electric fields established within the cell membrane by large, induced transmembrane potential attract water into the membrane until large pores or defects form. Electroporation occurs in less than one millisecond, and most cell membranes rupture when more than 0.8 to 1 V of transmembrane potential is imposed. The pattern of tissue injury is also a consequence of the body's electrical properties. All tissues except the skin are relatively good conductors.
Large currents can then pass and produce tissue damage, especially to skeletal muscle and nerve.
The most challenging aspect of acute treatment is that the tissue in the electric current path unless there has been significant heating may appear grossly normal. Typically, it is at least 1 to 3 days before the true extent of damage can be recognized. Furthermore, healthy skin and fat often conceal injured muscles, nerves, and bone. Thus, it is very difficult to accurately diagnose and localize tissue damage scattered throughout the current path before irreversible cellular degeneration has occurred. This is why it is so critically important to develop new imaging techniques that would allow surgeons to immediately recognize the full extent of tissue injury and take appropriate steps at clinical management.