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SMOKE INHALATION/BURNS (RESPIRATORY MANAGEMENT (Airway Management,…
SMOKE INHALATION/BURNS
PATHOPHYSIOLOGY
Inhalation Injury:
Dependent on stage- Early, Intermediate and Late stages
Direct thermal damage to the upper airway from inhaling hot gases.
Chemical injury to the lungs due to inhalation of toxic by-products of combustion found in smoke.
Damage to O2 delivery and cellular O2 utilization through exposure to CO or hydrogen cyanide.
Flame Exposure, Hot Liquids, Electrical/Chemical:
Indirectly affect the lungs causing bronchconstriction,
non-cardiogenic pulmonary edema and in worse cases ARDS.
Severity dependent on BSA affected and burn depth: First, Second and Third degree
CLINICAL S/S
CN Poisoning:
headache, confusion seizures or coma, chest tightness, nausea/vomiting, mydriasis, dyspnea, hypernea, hypertension (early), Hypotension (late)
Inhalation Injury:
facial/neck burns, singed nose hairs, sooty sputum, cyanosis,hoarseness, coughing, stridor
RESPIRATORY MANAGEMENT
Airway Management
Mechanical Ventilation Protocol
Oxygen Therapy Protocol
VAP Protocol
NHLBI protocol
Four R's:
Resuscitation, Resurfacing, Rehabilitation, and Reconstruction
DIFFERENTIAL DIAGNOSIS
Heat
Chemical
Smoke
Electrical
ETIOLOGY
Exposure to the following:
Thermal injuries, Flame exposure,
Hot liquids, Electrical/Chemical
DIAGNOSTIC TESTS
Labs
CXR
Fiberoptic Bronch
ABG
:
CBC, electrolytes, lactate, ABG, Co-oximetry, coagulation profile
Used to assess more severe burns - ARDS and PNA
Assessment of airway damage
Sats > 90%, Co-oximetry needed
Humification, allow mild/moderate resp acidosis to prevent pulmonary injury
If vocal cords are damaged or the patient is likely o require MV > 10-12 days ---> recommend tracheostomy
ARDS- If P/F ratio < 300, B/L diffuse infiltrates
Early:
Inc pH, Dec PaCO2, Dec HCO3-, Dec PaO2, Dec SaO2
Late
: Inc COHb, Dec pH (lactic acidemia) , Dec PaCO2, Dec HCO3-, Dec PaO2, Dec SaO2
Severe cases of ARDS, PaCO2 may be elevated and combined respiratory and metabolic acidosis may be present
Acute Ventilatory Failure:
Inc COHb, Dec pH, Inc PaCO2, Dec HCO3-, Dec PaO2, Dec SaO2