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Inhalation Injuries
Shaila DeLea DO PGY2
Maine Medical Center
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Overview
• Types of inhalational injuries
• Smoke inhalation
• Pathophysiology
• Acute presentation
• Management
• Mechanical ventilation
• Supportive
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• <b>Simple asphyxiants</b>
• Work exposure
• Intentional inhalation
• <b>Pulmonary Irritants</b>
• Home products
• Large scale catastrophes (Bhopal, India 1984)
• <b>Smoke inhalation</b>
• Thermal injuries
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Simple Asphyxiants
• Non toxic/minimally toxic gas
• Nitrogen, argon, helium, butane, propane
• Inert and odorless
• Displaces oxygen and lowers inhaled fraction of
oxygen
• Acute effects in minutes due to hypoxia
• Removal from gas resolves hypoxia
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Pulmonary Irritants
• Environmental exposure
• Direct cellular toxicity
• Effects based on water
solubility
• High: mucous membrane
irritation
• Low: delayed lower airway
toxicity
<b>Intermediate</b>
<b>High</b>
<b>High</b>
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Upper airway
swelling
Chemical
Intoxication
Acute Respiratory
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Upper Airway Injury
• Thermal injury
• Airway swelling
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Lower Airway Injury
• Chemical damage
• Surfactant loss
• Alveolar collapse
• Stress response
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Parenchymal Injury
• Delayed atelectasis and
alveolar collapse
• Impaired oxygenation
• Fibrin deposition
• VQ mismatch
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History and Physical
• Chemical vs smoke vs flame
• Duration
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Signs & Symptoms
• Upper airway:
• Hoarseness
• Stridor
• Lower airway:
• Tachypnea
• Cough
• Abnormal or absent breath
sounds
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Initial Work Up
• ABCs
• Labs
• CBC
• BMP
• Lactate
• Toxicology screen
• ABG
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Low Risk Patients
LOW RISK
Monitor 4-6 hours
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Airway Management
• Humidified oxygen
• NIPPV
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Airway Management
• Consider early intubation
• Complications:
• Delayed inflammation and
edema
• Sepsis
• ARDS
• PNA
• Need for OR
• Ventilation strategy
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ECMO
Extracorporeal membrane oxygenation
• Indicated for severe respiratory or
cardiac failure
• Must be reversible and
unresponsive to conventional
management
• Venoarterial (VA) and venovenous
(VV)
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Abbreviated Injury Score (AIS)
<b>Score</b> <b>Class</b> <b>Description</b>
0 No injury No carbonaceous deposits, erythema, edema,
bronchorrhea, obstruction
1 Mild Minor patchy areas of erythema, deposits in proximal or
distal bronchi
2 Moderate Moderate erythema and deposits, bronchorrhea
3 Severe Severe inflammation with friability, copious
carbonaceous deposits
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Pulmonary Care
• Bronchodilators
• Airway clearance
• Mucolytics
• Chest physiotherapy
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Summary
• Burn + Pulmonary injury = increased mortality
• Early death is due to hypoxia, airway compromise, metabolic
derangements
• Secure the airway early!
• Always consider CO and cyanide poisoning
• Bronchoscopy is both therapeutic and diagnostic
• Good pulmonary care improves outcomes
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