Inhalation injury: Difference between revisions

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* Hyperacute - severe [[wheezing]], [[bronchoconstriction]], significant [[hypoxemia]]
* Hyperacute - severe [[wheezing]], [[bronchoconstriction]], significant [[hypoxemia]]
* Acute [[pulmonary edema]] - onset at 48-72 hours post injury in a previously asymptomatic patient
* Acute [[pulmonary edema]] - onset at 48-72 hours post injury in a previously asymptomatic patient
* Broncho[[pneumonia]] often at 10 days post-inury
* Broncho[[pneumonia]] often at 10 days post-injury


==Differential Diagnosis==
==Differential Diagnosis==
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: Examples - smoke inhalation from burning building, leak of a solvent, chemical fumes
: Examples - smoke inhalation from burning building, leak of a solvent, chemical fumes
* Physical examination with focus on airway and pulmonary system
* Physical examination with focus on airway and pulmonary system
* Observe of evidence of airway compromise or respiratory distress
* Observe for evidence of airway compromise or respiratory distress
* [[Chest x-ray]], pulse oximetry, [[ABG|arterial blood gas]]
* Consider [[carbon monoxide toxicity|carboxyhemoglobin]] and/or [[cyanide]] level if any suspicion based on history


==Management==
==Management==
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* Separate patient from fumes/toxic agent  
* Separate patient from fumes/toxic agent  
* Decontaminate if not done on scene
* Decontaminate if not done on scene
* Secure airway if necessary and ventilate
* Secure airway if necessary and ventilate, observe for respiratory distress and airway compromise
* [[Oxygen]] at 6-12 liters per minute via mask
* [[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===
===Inert Gases===
* Remove victim from the gas
* Remove victim from the gas
* Fresh air or oxygen
* Fresh air or oxygen
* Observe for sequelae  from hypoxia (myocardial infarction, cerebral injury)
* Observe for sequelae  from [[hypoxia]] ([[myocardial infarction]], cerebral injury)
 
===Allergic===
===Allergic===
* Aerosolized [[bronchodilators]]
* Aerosolized [[bronchodilators]]
* [[Corticosteroids]] in patients with history of reactive airway disease
* [[Corticosteroids]] in patients with history of reactive airway disease
===Smoke Inhalation / Thermals===
===Smoke Inhalation / Thermals===
* Ensure adequate oxygenation, ventilation, pulmonary toilet and fluid resuscitation
* Ensure adequate oxygenation, ventilation, pulmonary toilet and [[IVF|fluid resuscitation]]


==Disposition==
==Disposition==

Latest revision as of 04:18, 21 April 2021

Background

  • Inhalational injury a concern with history of being trapped in enclosed space for some time with toxic gases / fumes

Clinical Features

General

Inert Gases

  • Inert gases (carbon dioxide, 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

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-injury

Differential Diagnosis

Inhalation injury

Unintentional
Terrorism

Burns

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

Management

General

  • Separate patient from fumes/toxic agent
  • Decontaminate if not done on scene
  • Secure airway if necessary and ventilate, observe for respiratory distress and airway compromise
  • Oxygen at 6-12 liters per minute via mask

Inert Gases

Allergic

Smoke Inhalation / Thermals

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

References