Inhalation injury: Difference between revisions
Neil.m.young (talk | contribs) (Text replacement - "==Diagnosis==" to "==Evaluation==") |
No edit summary |
||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
* Inhalational injury a concern with history of being trapped in enclosed space for some time with toxic gases / fumes | |||
==Clinical Features== | ==Clinical Features== | ||
* Initial signs/symptoms - coughing, wheezing, dyspnea, irritated mucous members (runny eyes/nose), chest pain, hypoxia | |||
* Specific features dependent on type of exposure | |||
===Inert Gases=== | |||
* Inert gases (carbon dioxise, fuel gases) displace air and oxygen producing asphyxia | |||
* Present with severe hypoxia | |||
===Irritant Gases=== | |||
* Irritant gases (ammonia, formaldehyde, chlorine, nitrogen dioxide) when dissolved in water lining respiratory tract produce a chemical burn and inflammatory response | |||
* More soluble the gas produces more upper airway burns/irritation symptoms | |||
* Less soluble gases produce more pulmonary injury and respiratory distress | |||
===Systemic Toxins=== | |||
* Includes carbon monoxide, hydrogen cyanide, hydrogen sulfide | |||
* Interfere with delivery of oxygen for use in cellular energy production | |||
* Liver, kidney, brain, lung and other organ damage | |||
===Allergic=== | |||
* Inhaled gases, particles, aerosols | |||
* Produce bronchospasms and edema similar to asthma | |||
===Smoke Inhalation / Thermal === | |||
* Most fatalities from burn injuries are attributed to smoke inhalation | |||
* Soot in posterior pharynx, singed nasal hair | |||
* Hyperacute - severe wheezing, bronchoconstriction, significant hypoxemia | |||
* Acute pulmonary edema - onset at 48-72 hours post injury in a previously asymptomatic patient | |||
* Bronchopneumonia often at 10 days post-inury | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 7: | Line 30: | ||
==Evaluation== | ==Evaluation== | ||
*Look for evidence of exposure | |||
** Estimated time of exposure | |||
** Open or enclosed space | |||
** Associated events such as fire, blast, etc.? | |||
** Is the exposure known? | |||
** Material on patient? Does patient smell of chemical? | |||
: Examples - smoke inhalation from burning building, leak of a solvent, chemical fumes | |||
* Physical examination with focus on airway and pulmonary system | |||
* Observe of evidence of airway compromise or respiratory distress | |||
==Management== | ==Management== | ||
===General=== | |||
* Separate patient from fumes/toxic agent | |||
* Decontaminate if not done on scene | |||
* Secure airway if necessary and ventilate | |||
* Oxygen at 6-12 liters per minute via mask | |||
* Chest x-ray, pulse oximetry, arterial blood gases | |||
* Consider carboxyhemoglobin level or cyanide level if any suspicion based on history | |||
* Observe for respiratory distress and airway compromise | |||
===Inert Gases=== | |||
* Remove victim from the gas | |||
* Fresh air or oxygen | |||
* Observe for sequelae from hypoxia (myocardial infarction, cerebral injury) | |||
===Allergic=== | |||
* Aerosolized bronchodilators | |||
* Corticosteroids in patients with history of reactive airway disease | |||
===Smoke Inhalation / Thermals=== | |||
* Ensure adequate oxygenation, ventilation, pulmonary toilet and fluid resuscitation | |||
==Disposition== | ==Disposition== | ||
* Respiratory distress or airway compromise will need admission | |||
* Observe for 1-4 hours if no signs or symptoms of inhalation injury develop or if all resolved within 1 hour consider discharging patient home with instructions for return for re-evaluation next day or sooner if pulmonary and/or airway symptoms develop | |||
==See Also== | ==See Also== | ||
| Line 21: | Line 72: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Environmental]] [[Category:Toxicology]] | |||
Revision as of 05:04, 3 February 2018
Background
- Inhalational injury a concern with history of being trapped in enclosed space for some time with toxic gases / fumes
Clinical Features
- Initial signs/symptoms - coughing, wheezing, dyspnea, irritated mucous members (runny eyes/nose), chest pain, hypoxia
- Specific features dependent on type of exposure
Inert Gases
- Inert gases (carbon dioxise, fuel gases) displace air and oxygen producing asphyxia
- Present with severe hypoxia
Irritant Gases
- Irritant gases (ammonia, formaldehyde, chlorine, nitrogen dioxide) when dissolved in water lining respiratory tract produce a chemical burn and inflammatory response
- More soluble the gas produces more upper airway burns/irritation symptoms
- Less soluble gases produce more pulmonary injury and respiratory distress
Systemic Toxins
- Includes carbon monoxide, hydrogen cyanide, hydrogen sulfide
- Interfere with delivery of oxygen for use in cellular energy production
- Liver, kidney, brain, lung and other organ damage
Allergic
- Inhaled gases, particles, aerosols
- Produce bronchospasms and edema similar to asthma
Smoke Inhalation / Thermal
- Most fatalities from burn injuries are attributed to smoke inhalation
- Soot in posterior pharynx, singed nasal hair
- Hyperacute - severe wheezing, bronchoconstriction, significant hypoxemia
- Acute pulmonary edema - onset at 48-72 hours post injury in a previously asymptomatic patient
- Bronchopneumonia often at 10 days post-inury
Differential Diagnosis
Inhalation injury
- Unintentional
- Smoke inhalation injury
- Chloramine
- Hydrocarbons
- Sewer gas
- Hydrazine toxicity
- Nitrogen tetroxide
- Metal fume fever
- Terrorism
- Pulmonary chemical agents
- Ammonia
- Methyl isocyanate
- methyl bromide
- Hydrochloric acid
- Chlorine
- Phosgene
- Bioterrorism
Evaluation
- Look for evidence of exposure
- Estimated time of exposure
- Open or enclosed space
- Associated events such as fire, blast, etc.?
- Is the exposure known?
- Material on patient? Does patient smell of chemical?
- Examples - smoke inhalation from burning building, leak of a solvent, chemical fumes
- Physical examination with focus on airway and pulmonary system
- Observe of evidence of airway compromise or respiratory distress
Management
General
- Separate patient from fumes/toxic agent
- Decontaminate if not done on scene
- Secure airway if necessary and ventilate
- Oxygen at 6-12 liters per minute via mask
- Chest x-ray, pulse oximetry, arterial blood gases
- Consider carboxyhemoglobin level or cyanide level if any suspicion based on history
- Observe for respiratory distress and airway compromise
Inert Gases
- Remove victim from the gas
- Fresh air or oxygen
- Observe for sequelae from hypoxia (myocardial infarction, cerebral injury)
Allergic
- Aerosolized bronchodilators
- Corticosteroids in patients with history of reactive airway disease
Smoke Inhalation / Thermals
- Ensure adequate oxygenation, ventilation, pulmonary toilet and fluid resuscitation
Disposition
- Respiratory distress or airway compromise will need admission
- Observe for 1-4 hours if no signs or symptoms of inhalation injury develop or if all resolved within 1 hour consider discharging patient home with instructions for return for re-evaluation next day or sooner if pulmonary and/or airway symptoms develop
See Also
External Links
Video
{{#widget:YouTube|id=CB10airH5Sg}}