Chemical And Thermal Injuries

Question 0

What are some causes of inhalational injury

Answer 0

Hot, dry gases

Steam

toxic/chemical/irritating gases

smoke

Question 1

What is the major concern with chemical and thermal injury in regards to the airway

Answer 1

Airway patency and oxygenation

Early airway control is key to maintaining the airway patency and oxygenation

Question 2

What are some pathophysiologies related to thermal injury

Answer 2

Carbon monoxide (CO) poisoning

cyanide (CN) poisoning

aspiration

Question 3

If the airway is directly involved in a thermal injury what causes a rapid loss of airway patency

Answer 3

Laryngeal edema

Question 4

If the airway is not directly involved what are some possible cardio respiratory effects that can impact oxygenation

Answer 4

Increased lung water

Lung injury causes increased lung water

also major burns with or without lung injury are usually resuscitated Vigorously with fluids, so this can increase the water in the lungs as well i.e. 3rd spacing

Question 5

What is the route of choice for airway maintenance in thermal injury

Answer 5

Oral ETT, if nasal is used to convert to OETT as soon as possible

Note: nasal And tracheal airways have risk of infection

Question 6

In order to evaluate the patient for discontinuing airway support, what should be done

Answer 6

A simple cuff leak test to confirm that there is no airway edema

Question 7

Suppose there is airway edema, How should you evaluate the patient prior to discontinuing airway support

Answer 7

DL under general anesthesia

Explain the procedure to the patient
make the patient NPO (Including parental) for 8 hours
induce with general anesthesia via ETT using Sevo and oxygen
maintain spontaneous ventilation
introduce laryngoscope & observe upper airway edema
decision point: if Airway okay then extubate, if not leave intubated And reevaluate 24 hours later

Question 8

What types of chemicals may have produced chemical injury in the airway

Answer 8

Acrolein - Released by cellulosic conflagration (Extensive fire ), can produce pulmonary edema

Ammonia

Cyanide – polyurethane conflagration

carbon monoxide – fires and incomplete combustion

HCL – PVC Confederation; severe mucosal burns in airway

Phosgene

Lye ingestion