T8: Smoke Inhalation Flashcards
smoke inhalation injury
damage from breathing noxious chemicals or hot air can cause damage to the tissues of the respiratory tract.
*Redness and airway edema may result.
smoke inhalation injury assessment
- Rapid initial and ongoing assessment is critical, needs to be treated quickly
*Assess for signs and symptoms of airway compromise and pulmonary edema that can develop over the first 12-48 hours.
what are the three types of smoke inhalation injury
*Metabolic asphyxiation
*Upper airway injury
*Lower airway injury
metabolic asphyxiation
Carbon monoxide (CO) poisoning
Inhaled CO DISPLACES oxygen
-Hypoxia
-Carboxyhemoglobinemia
-Death
treatment for carbon monoxide poisoning
100% humidified oxygen
Upper airway injury
*Injury to mouth, oropharynx, and/or larynx
*Thermally produced
*Hot air, steam, or smoke
*Swelling may be massive and onset rapid
swelling in upper airway breathing can lead to
-Eschar and edema may compromise breathing
-Swelling from scald burns can be lethal
Clues to upper airway injury
-Presence of facial burns
-Singed nasal hair
-Hoarseness, painful swallowing
-Darkened oral and nasal membranes
-Carbonaceous sputum
-History of being burned in enclosed space
-Clothing burns around neck and chest
lower airway injury
*Injury to trachea, bronchioles, and alveoli
*Injury is related to length of exposure to smoke or toxic fumes
pulmonary edema of lower airway injury may not appear until
12-48 hours after burn
pulmonary edema in lower airway injury manifests as
acute respiratory distress syndrome (ARDS)
interventions for lower airway injury
-give MASK (HUMIDIFIED MASK) 100% VENTURI MASK
-may need intubation for swelling
-vent with PEEP
-do not lay flat
Severity of burn injury is determined by
location of burn wound
burns to the face, neck, and chest are concern for
respiratory obstruction, loss of airway
burns to the hands, feet, joints, eyes are concern because
*they make self-care very difficult and may jeopardize future function.
burns to the ears, nose, buttocks, perineum are concern because
at high risk for infection from urine or feces contamination
patient risk factor for poorer prognosis with burn/smoke inhalation injury
-Preexisting heart, lung, and kidney diseases contribute to poorer prognosis
-Diabetes mellitus and peripheral vascular disease contribute to poor healing and gangrene
what physical weakness renders patient less able to recover with burn/smoke inhalation injury
*Alcoholism
*Drug abuse
*Malnutrition
-Concurrent fractures, head injuries, or other trauma leads to a more difficult time recovering
inhalation injury: prehospital phase
*Watch for signs of respiratory distress
*Treat quickly and efficiently
*Use special SpCO oximetry (normal SpO2 is unreliable)
*100% humidified oxygen if CO poisoning is suspected-continue until carboxyhemoglobin levels return to normal
SpCO measures
carbon monoxide
labs for carbon monoxide poisoning
carboxyhemoglobin levels
signs of impending respiratory distress
increased agitation, anxiety, restlessness, or a change in the rate or character of the patient’s breathing
Pneumonia is a common complication of major burns, so…
do oral care, get up to a chair, they may not want to cough or deep breathe depending on where the burn is
impaired gas exchange with lower airway injury because
O2 and CO2 exchange happens in the alveoli
emergent phase: airway management
*Early endotracheal intubation-1-2 hours of injury
*PEEP to prevent actelectasis
*Escharotomies of the chest wall for expansion
*Fiberoptic bronchoscopy same day of injury to assess damage
*Humidified air and 100% oxygen
-Pulse CO2 oximetry monitoring
fiberoptic bronchoscopy
procedure using flexible, light-transmitting plastic fibers to visualize the bronchi
patient prep for fiberoptic bronchoscopy
NPO to avoid aspiration, sedate them and assess damage
post fiberoptic bronchoscopy
do not feed them , watch for them coughing up blood, get chest x ray after to make sure nothing else happened, baseline VS, IV access, HOB up or side lying
interventions for non intubated clients
-high Fowler’s position
-coughing and deep breathing every hour
-Reposition the patient every 1 to 2 hours
-chest physiotherapy and suctioning as ordered
Patient with CO (carbon monoxide) poisoning will have normal SPO2 in spite of elevated CO levels, soo…
Use of SPCO monitor needed
