Lung Injury from hydrocarbon

Question 1

Most common and serious complication

Answer 1

pneumonitis

Question 2

aspiration high likely if

surface tension
low viscosity
volatility

Answer 2

low surface tension (adherance to surface)

low viscosity (spread easily, seep deeper in TISSUES)

HIGH VOLATILITY (rapid blood stream absorption; spread easily in ALVEOLI interfering gas exchange)

Question 3

Chemical pneumonitis due to hydrocarbon may have radiologic signs within _____

Answer 3

2 hours (88%)
6-12 hrs (98%)

Question 4

severe injury due to hydrocarbon

Answer 4

hemoptysis
pulmonary edema
respi failure within 24 hrs

Question 5

radio signs

Answer 5

Punctate
mottled densities
pneumonitis
atelectasis

Question 6

blood gas in hydrocarbon hypoxemia without hypercapnia suggesting

Answer 6

vq mismatch or diffusion block
*destruction of epithelium, bronchospasm

*displacement of alveolar gas

Question 7

management

Answer 7

Intratracheal surfuctant
peep
ecmo / hfov
antibiotics

Question 8

PULMO function in hydrocarbon

Answer 8

Increase RV/TLC
high volume of ISOFLOW
increased slope of phase III

low FEV1

suggest small airway obstruction

Question 9

long term ff up showed residual injury to

Answer 9

peripheral airways

Question 10

prognosis depends

Answer 10

ph
volume
type

Question 11

hydrocarbon sniffing

Answer 11

results to acute hypoxemia
(displacement of alveolar gas)

Question 12

3rd MC cause of poisoning deaths <5 yo
highest Morbidity and mortality <5 yo

Answer 12

Hydrocarbon aspiration and inhalational injury

Question 13

common among
poor
african American
native american
<4 yo
and >85 yo

Answer 13

smoke inhalation

Question 14

Blood gas of Carbon monoxide poisoning

Answer 14

O2 sat is low
Normal PaO2

*ABG obtained along COHb

Question 15

Initial pathologic changes in smoke inhalation

Answer 15

Tracheobronchitis

Question 16

Acute pulmonary edema caused by increased vascular permeability can occur within ____

Answer 16

30 minutes

Question 17

Upper airway obstruction occurs within ___ and can lead to alveolar hypoventilation

Answer 17

24 hours

Question 18

VQ mismatch of carbon monoxide is due to

Answer 18

Inflammatory changes in the airways

Question 19

Bronchial and bronchiolar edema leads to _______ airway resistance

Answer 19

HIGH

Question 20

Inhaled cyanide binds to _______ system
Inhibits cell metabolism and production of ATP

Answer 20

Cytochrome

Question 21

Clinical findings focus on

Answer 21

Hypoxemia, cyanosis

Question 22

How many % of COHb would lead to confusion, hallucination, ataxia, coma

Answer 22

40%

*increases cerebral blood flow
Permeability of cerebral capillaries
Cerebropspinal fluid pressure

Question 23

Sensitive indicator of cyanide poisoning

Answer 23

Plasma lactate concentration >10mM

Question 24

Manifestation of respi distress on cyanide develop within

Answer 24

12 hours-24 hours

Question 25

Used in early assessment of the extent of supraglottic or tracheobronchial injury

Answer 25

Flexible fiberoptic nasopharyngoscopy or bronchoscopy

Question 26

Chest Xray is not helpful in early diagnosis because in cyanide poisoning

Answer 26

Findings lag several hours

Question 27

Should be done before head and neck swelling, which make this examination difficult

Answer 27

Direct laryngoscopy

Question 28

Evaluate the extent of mucosal damage

Answer 28

Fiberoptic bronchoscopy

Question 29

Administering 100% O2 may reverse CO poisoning reducing by _____ in about an hour

Answer 29

HALF *O2 for bronchiolitis and alveoliis with premature closure of small airways

Question 30

Can cause increased airway resistance from edema and some reflex bronchoconstriction from airway receptors

Answer 30

Inhaled bronchodilators *smokers, CF

Question 31

SIGNIFICANT decrease reintubation incidence and incidence of atelectasis Reduced mortality

Answer 31

Nebulized Heparin and N-acetylcysteine

Question 32

Pulmonary damage from smoke inhalation shows within _____ hours

Answer 32

24

Question 33

IV fluid can cause pulmonary edema by

Answer 33

Pulmonary vascular engorgement Increases vascular permeability with fluid leak

Question 34

Increases risk for hypoventilation and atelectasis

Answer 34

Chest wall edema or eschar formation

Question 35

Severity of pulmonary parenchymal injury depends on

Answer 35

Duration of exposure Type of inhalant

Question 36

IMPACT of smoke inhalation on long term lung function depends on

Answer 36

Stage of lung developmenet AT THE TIME OF INJURY Confounding lung injury from (ARDS, pneumonia, acute lung injury)

Question 37

PFT after 8 yrs following thermal injury

Answer 37

Obstructive Mixed obstructive and Restrictive