Inhalation Injury Flashcards
What is classification of inhalation injuries based on?
- Anatomical structure: URT, LRT injuries
- Irritants: chemicals, poison gases & hot gases
What are the types of irritant inhalation injuries?
- Chemicals: associated with industrial accidents or home drug laboratory
- Poison gases: associated with industrial accidents and house fire
- Hot gases: steam & flame (domestic, industrial, BBQ or bombing)
What are the characteristics of chemical inhalation injuries?
- Acid or alkaline
- In forms of powders (particle size and solubility determines how far they travel)
- Destroy lung tissue
- Limited offer from chest physiotherapy
- If survive, focus on cardio-pulmonary fitness
What are the characteristics of poison gas inhalation injuries?
- Leading to hypoxic brain damage
- CoHb as indicator
- May not have much cutaneous burns
- Limited offer from chest physiotherapy
- Primarily for maintenance
What are the characteristics of hot gas inhalation injuries?
- Always associated with head/neck burns & thoracic/abdominal burns
- Damage to the upper airways
- Affect proper lung function
- Common signs as singed hair and soot in sputum
- Required intubation and aggressive chest physiotherapy
What is an echarotomy?
- Common procedure for cutaneous burns
- Aimed to release compartment pressure to allow blood flow to distal part of limbs with circumferential burns
- Echarotomy of chest and abdomen for respiratory function
- Consider chest expansion and changes of thoracic and abdominal pressure
What is carbon monoxide toxicity?
- Produced due to incomplete combustion
- CO affinity to Hb 200-250x affinity of O2 to Hb
- Results in decreased oxyhemoglobin saturation
What are the signs & symptoms of CO2 toxicity?
- Tightness over forehead
- Dilation of cutaneous blood vessels
- Throbbing headache
- Severe headache, vomiting & dimness of vision
- Increased pulse/RR, possibility of collapse
- Syncope, intermittent convulsions
- Coma, depressed cardiac & respiratory function
What does reversal of CO2 toxicity depend on?
- Availability fo O2 & half life of CO
- 250mins in room air
- 40-60mins if given 100% O2
- 30mins if 3atm pressure & 100% O2 given
What is hydrogen cyanide toxicity?
- Produced in fires involving nitrogen-containing polymers
- Toxicity produced by inhibition of cellular oxygenation, caused by reversible inhibition of cytochrome oxidase
- Underlying lactic acidosis not responsive to O2 therapy
What are the signs & symptoms of hydrogen cyanide toxicity?
- Lethargy
- Nausea
- Weakness
- Coma
- Mimic and acute MI
What does chest physio for intubated severe burns include?
- Check cervical spine and ribs fracture
- MHI (check respiratory support parameters) & suctioning
- Postural drainage
- Percs & vibes (no manual technique after skin grafting until Day 5)
- Early mobilisation
What does treatment after extubation include?
- ACBT & deep breathing exercises
- Continue with manual techniques
- Coughing
- Active exercise & SOOB
- Suctioning
- Gradual increase in ambulation (to improve lung function & sense of self control)
What are the considerations for escharotomy of cutaneous burns?
- Acute swelling induced by inflammatory responses
- Underlying tissues (esp. soft tissues) being compressed
- Further restricted blood flow to distal parts of limbs causing AVN
- Also aware of compartment syndrome
What additional respiratory/cardiac insults should be considered?
- Stephen Johnson or TENS
- Respiratory: Asthma, CAL, heavy smoker
- Cardiac issues leading to pulmonary oedema, PE or pulmonary insufficiency with excessive fluid resuscitation
