Smoke Inhalation Flashcards
Define inhalation injury
Nonspecific term respiratory tract or tissue damage from heat, smoke, or chemical irritants
Define burn injury
Traumatic injury to skin or other tissue mostly caused by thermal or other acute exposures
Occurs when skin or other tissue is destroyed
What causes burn injury
Heat
Electrical damage
Friction
Chemicals
Radiation
What factors influence the severity of smoke inhalation
Duration
Chemical
Size and diameter
Temp of gas
Age
Pre-existing health
Size and depth of burns
What are the two types of smoke
Pyrolysis
Combustion
What are the two types of common toxins found in smoke
Carbon monoxide
Hydrogen cyanide
Hazards of skin burns
Destroys the barrier from pathogens
Barrier contains water
What is the “rule of 9s”
Provides a quick estimate of the total estimate of body surface burned
According to the nines rule, the: head is how much
Nine per side
According to the nines rule, the: arm is how much
9 per arm
According to the nines rule, the: body is how much
18 front and back
According to the nines rule, the: genitals is how much
1
According to the nines rule, the: legs is how much
18 each
Explain the correlation between age, body surface burns and mortality
The older you are, less burns have higher mortality
Explain the characteristics of a superficial burn
First degree
Epidermal
No blisters
Bleach with pressure
No pain in 2-3 days
Heals in 6 with no scarring
What are the characteristics of partial thickness burns
Epidermis and some dermis
Superficial or deep classification
Second degree
What are the characteristics of superficial partial thickness burns
Blisters in 24hrs
first looks like only epidermis; dermis appears damaged after 12-24 hrs
Heals in 7-21 days
Usually doesn’t scare, but pigment change
What are the characteristics of deep partial thickness burns
Reaches deeper dermis
Damage to follicles and glandular tissue
Pain only to pressure
Cheesy white to red
Hypertrophic scarring
If it fails to heal in 2 wks it is cosmetically and functionally a full-thickness burn
What are the characteristics of full thickness burns
Through dermis to subcutaneous
Dry inelastic doesn’t blanch to pressure
Burn eschar remains intact, but once separated unhealed granulation tissue remains
May not heal on there own
If it reaches muscle or bone can be life-threatening
How is thermal injury caused
Upper AW usually absorbs heat, so it absorbs excessive heat
What does thermal injury cause
Pharyngeal edema and swelling
Stridor
Hoarseness
Altered voice
Painful swallow
Does thermal injury usually occur below larynx
Not unless it is steam inhalation
What protects the lower respiratory tract from thermal injury
Upper AW which can cool the air/ absorb (Heat sink)
What are the stages of smoke inhalation
Early
Intermediate
Late
What happens during the early stage of smoke inhalation
Tracheobrachial tree is inflamed
Bronchospasm
Secretions move into AW
Smoke slows down mucosal cilliary transport
Cardiogenic hazards associated with smoke inhalation (early stage)
Hypovolemia
Hypoxia
Increased systemic and pul resistance
CO poisoning
What happens to vessels with smoke inhalation injury during early stage
Mediators increase permeability
Leak into third space
Much fluid but no in circulation
When does generalization of edema peak with smoke inhalation injury
8-24 hours
What is the timeline of intermediate burn inhalation injury
2-5 days
What happens during intermediate smoke inhalation injury
Tracheobronchial tree becomes necrotic and sloughs
ARDS may develop
More mucus
What occurs during late smoke inhalation injury
Infection of body surface
PNA
Pulmonary Embolism
Restrictive or obstructive disorder
What problem accompany CO
SpO2 misleading
How does cyanide alter the body
In the mitochondria it binds to cytochrome oxidase enzyme so it’s unable to metabolize O2
What are signs of smoke inhalation
Soot
Oral or laryngeal edema
Cyanosis
Cough with sputum
Is smoke inhalation usually restrictive or obstructive
Usually restrictive, but can be obstructive with airway construction
What percentage indicates COHB intoxication
Greater than 20 percent
What are the key initial assessment for patients with burn or smoke injury
ABC
Respiratory status
Cardiovascular status
Extent of burns
Depth of burns
What questions do you ask patients suspected on smoke inhalation
Closed or open space
What type of material was burning
Was CO or cyanide produced
Was the patient conscious on arrival
Does history indicate test for blood alcohol levels, for poisoning, or O.D.
What is a ideal ETT for a patient with smoke inhalation
8.0-8.5 for bronchoscopy
Benefits of covering burn wounds
Prevent:
shock
Fluid loss
Heat loss
Pain
How do we prevent infection for burn victims
Reverse isolation
Positive pressure room
Air filtration
Wound covering
How do you treat CO poisoning
High FiO2
Hyperbaric oxygen
What medication do you treat cyanide poisoning with
Hydoxocobalamin IV
(Urine looks grape)
Can’t do ABG
What aerosols are given to burn patients
5k-10k heparin in 3mL Q4
Alternating with
20% NAC Q4
(For seven days)
How does NAC and heparin aid in burn care
Reduces the formation of fibrin casts in the AW
Serve as scavengers for reactive O2 species and may reduce injury
How do you treat secretions for patients with smoke inhalation injury
Sx
IPV
Bronchoscopy if needed
Combustion gas expectation
Explodes with oxygen
Pyrolysis
Smolders in low oxygen
Why with CO poisoning is there a decrease in bicarbonate and pH with a low CO2
Inability to use O2 causes anaerobic metabolism and creating lactic acid
