Inhalation Inhalation injuryinjury

Helena Croft

JAHD 1st May 2012

contentscontents• What is inhalation injury• Mechanism of injury• Treatment• Prognosis• Research summary

• Present in 10-30% of burns cases• 75% of burns related deaths• Delayed presentation• Most common in under 5’s and over 75’s• Risks – enclosed space, increased time, underlying respiratory disease.

Mechanisms of injuryMechanisms of injury• Thermal damage - upper airways - obstructive pattern in first 12 or so hours

• Asphyxiation – CO higher affinity for Hb - disassociation curve shifts to the left worsening tissue hypoxia,

• Irritation - damage to parenchyma - products of incomplete combustion

PathophysiologyPathophysiology• Oedema – progressive ranging from mild to serve and associated with cast formation.

• Decreased pulmonary compliance• Inactivation of surfactant• Destruction of cilia • Risk of ARDS

assessmentassessment

ManagementManagement• Resuscitation – fluids, high flow O2• Airway management – possible intubation• ventilation• Chest physio• Pharmacological agents• Management of late complications

Titrate humidified oxygen to maintain SaO2s’ > 90%Cough, deep breath exercises every 2 hTurn patient side to side every 2 hChest physiotherapy every 4 hAerosolize 3 cc’s of 20% N-acetylcysteine every 4 h with abronchodilatorAlternate aerosolizing 5000 units of Heparin with 3 cc’s ofnormal saline every 4 hNasotracheal suctioning as neededEarly ambulation on post-operative day 5Sputum cultures for intubated patients every Monday,Wednesday, FridayPulmonary function studies prior to discharge and at out-patientvisitsPatient/family education regarding inhalation injuryThe protocol is continued for 7 days.