0 No injury No carbonaceous deposits, erythema, edema, bronchorrhea, obstruction. 1 Mild Minor patchy areas of erythema, deposits in proximal or distal bronchi[r]
(1)Inhalation Injuries
Shaila DeLea DO PGY2 Maine Medical Center
(2)Overview
• Types of inhalational injuries • Smoke inhalation
• Pathophysiology
• Acute presentation • Management
• Mechanical ventilation • Supportive
(3)• Simple asphyxiants
• Work exposure
• Intentional inhalation
• Pulmonary Irritants
• Home products
• Large scale catastrophes (Bhopal, India 1984)
• Smoke inhalation
• Thermal injuries
(4)Simple Asphyxiants
• Non toxic/minimally toxic gas
• Nitrogen, argon, helium, butane, propane
• Inert and odorless
• Displaces oxygen and lowers inhaled fraction of oxygen
• Acute effects in minutes due to hypoxia • Removal from gas resolves hypoxia
(5)Pulmonary Irritants
• Environmental exposure • Direct cellular toxicity
• Effects based on water solubility
• High: mucous membrane irritation
• Low: delayed lower airway toxicity
Intermediate
High High
(6)(7)Upper airway swelling
Chemical Intoxication Acute Respiratory
(8)Upper Airway Injury
• Thermal injury • Airway swelling
(9)Lower Airway Injury
• Chemical damage • Surfactant loss
• Alveolar collapse • Stress response
(10)Parenchymal Injury
• Delayed atelectasis and alveolar collapse
• Impaired oxygenation • Fibrin deposition
• VQ mismatch
(11)(12)History and Physical
• Chemical vs smoke vs flame • Duration
(13)(14)Signs & Symptoms
• Upper airway:
• Hoarseness • Stridor
• Lower airway:
• Tachypnea • Cough
• Abnormal or absent breath sounds
(15)(16)Initial Work Up
• ABCs • Labs
• CBC • BMP • Lactate
• Toxicology screen • ABG
(17)Low Risk Patients
LOW RISK
Monitor 4-6 hours
(18)Airway Management
• Humidified oxygen • NIPPV
(19)Airway Management
• Consider early intubation • Complications:
• Delayed inflammation and edema
• Sepsis • ARDS • PNA
• Need for OR
• Ventilation strategy
(20)ECMO
Extracorporeal membrane oxygenation
• Indicated for severe respiratory or cardiac failure
• Must be reversible and
unresponsive to conventional management
• Venoarterial (VA) and venovenous (VV)
(21)(22)Abbreviated Injury Score (AIS)
Score Class Description
0 No injury No carbonaceous deposits, erythema, edema, bronchorrhea, obstruction
1 Mild Minor patchy areas of erythema, deposits in proximal or distal bronchi
2 Moderate Moderate erythema and deposits, bronchorrhea Severe Severe inflammation with friability, copious
carbonaceous deposits
(23)Pulmonary Care
• Bronchodilators • Airway clearance
• Mucolytics
• Chest physiotherapy
(24)Summary
• Burn + Pulmonary injury = increased mortality
• Early death is due to hypoxia, airway compromise, metabolic derangements
• Secure the airway early!
• Always consider CO and cyanide poisoning
• Bronchoscopy is both therapeutic and diagnostic • Good pulmonary care improves outcomes
(25)