T8: Smoke Inhalation

Question 1

smoke inhalation injury

Answer 1

damage from breathing noxious chemicals or hot air can cause damage to the tissues of the respiratory tract.
*Redness and airway edema may result.

Question 2

smoke inhalation injury assessment

Answer 2

• 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.

Question 3

what are the three types of smoke inhalation injury

Answer 3

*Metabolic asphyxiation
*Upper airway injury
*Lower airway injury

Question 4

metabolic asphyxiation

Answer 4

Carbon monoxide (CO) poisoning

Inhaled CO DISPLACES oxygen
-Hypoxia
-Carboxyhemoglobinemia
-Death

Question 5

treatment for carbon monoxide poisoning

Answer 5

100% humidified oxygen

Question 6

Upper airway injury

Answer 6

*Injury to mouth, oropharynx, and/or larynx
*Thermally produced
*Hot air, steam, or smoke
*Swelling may be massive and onset rapid

Question 7

swelling in upper airway breathing can lead to

Answer 7

-Eschar and edema may compromise breathing
-Swelling from scald burns can be lethal

Question 8

Clues to upper airway injury

Answer 8

-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

Question 9

lower airway injury

Answer 9

*Injury to trachea, bronchioles, and alveoli
*Injury is related to length of exposure to smoke or toxic fumes

Question 10

pulmonary edema of lower airway injury may not appear until

Answer 10

12-48 hours after burn

Question 11

pulmonary edema in lower airway injury manifests as

Answer 11

acute respiratory distress syndrome (ARDS)

Question 12

interventions for lower airway injury

Answer 12

-give MASK (HUMIDIFIED MASK) 100% VENTURI MASK
-may need intubation for swelling
-vent with PEEP
-do not lay flat

Question 13

Severity of burn injury is determined by

Answer 13

location of burn wound

Question 14

burns to the face, neck, and chest are concern for

Answer 14

respiratory obstruction, loss of airway

Question 15

burns to the hands, feet, joints, eyes are concern because

Answer 15

*they make self-care very difficult and may jeopardize future function.

Question 16

burns to the ears, nose, buttocks, perineum are concern because

Answer 16

at high risk for infection from urine or feces contamination

Question 17

patient risk factor for poorer prognosis with burn/smoke inhalation injury

Answer 17

-Preexisting heart, lung, and kidney diseases contribute to poorer prognosis
-Diabetes mellitus and peripheral vascular disease contribute to poor healing and gangrene

Question 18

what physical weakness renders patient less able to recover with burn/smoke inhalation injury

Answer 18

*Alcoholism
*Drug abuse
*Malnutrition
-Concurrent fractures, head injuries, or other trauma leads to a more difficult time recovering

Question 19

inhalation injury: prehospital phase

Answer 19

*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

Question 20

SpCO measures

Answer 20

carbon monoxide

Question 21

labs for carbon monoxide poisoning

Answer 21

carboxyhemoglobin levels

Question 22

signs of impending respiratory distress

Answer 22

increased agitation, anxiety, restlessness, or a change in the rate or character of the patient’s breathing

Question 23

Pneumonia is a common complication of major burns, so…

Answer 23

do oral care, get up to a chair, they may not want to cough or deep breathe depending on where the burn is

Question 24

impaired gas exchange with lower airway injury because

Answer 24

O2 and CO2 exchange happens in the alveoli

Question 25

emergent phase: airway management

Answer 25

*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

Question 26

fiberoptic bronchoscopy

Answer 26

procedure using flexible, light-transmitting plastic fibers to visualize the bronchi

Question 27

patient prep for fiberoptic bronchoscopy

Answer 27

NPO to avoid aspiration, sedate them and assess damage

Question 28

post fiberoptic bronchoscopy

Answer 28

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

Question 29

interventions for non intubated clients

Answer 29

-high Fowler’s position
-coughing and deep breathing every hour
-Reposition the patient every 1 to 2 hours
-chest physiotherapy and suctioning as ordered

Question 30

Patient with CO (carbon monoxide) poisoning will have normal SPO2 in spite of elevated CO levels, soo…

Answer 30

Use of SPCO monitor needed