Smoke inhalation, thermal lung injuries and CO intoxication
Thermal injuries: injuries caused by inhalation of hot gases usually affects the upper airways, and in
some cases, it will affect the distal airways caused by (Ability of upper airways to cool hot gases,
Reflex laryngospasm and Glottic closure)
Smoke inhalation injuries: damage caused by inhaling harmful gases. Such as, Irritating and toxic
gases > Suspended soot particles > Vapors associated with incomplete combustion and smoke.
The stages of smoke inhalation:
Early stage (0-24 hours): tracheobronchial tree becomes more inflamed, resulting bronchospasm.
This causes an overabundance of bronchial secretions to move into the airways, resulting in further
airway obstruction
Intermediate stage (2-4 days): there will be upper airway thermal injuries usually begin to improve.
the pathologic changes deep in the lungs continue to be a problem
Late stage (5days and longer): Infections resulting from burn wounds on the body surface. These
infections often lead to sepsis and multiorgan dysfunction syndrome (MODS), Pneumonia and
pulmonary embolism. long term effects in restrictive and obstructive lung disorders
Anatomic alterations of thermal injuries: •Blistering •Mucosal edema •Vascular congestion
•Epithelial sloughing Thick secretions •Acute upper airway obstruction
Anatomic alterations of smoke inhalation: • Inflammation of the tracheobronchial tree •
Bronchospasm • Excessive bronchial secretions and mucous plugging Decreased mucosal ciliary
transport • Atelectasis • Alveolar edema and frothy secretions (pulmonary edema) • ARDS (severe
cases) • Cryptogenic organizing pneumonia (COP) • Alveolar fibrosis, bronchial stenosis, bronchial
polyps, bronchiolitis, and bronchiectasis (severe cases)
Body surface burns:
First-degree burn (minimal depth in skin): Superficial burn, damage limited to the outer layer of epidermis
Healing time is about 6 to 10 days
Second- degree burn (superficial to deep thickness of skin): Burns in which damage extends through the
epidermis and into the dermis. Healing time is about 7 to 21 days
Third-degree burn Third-degree burn (full thickness of skin including tissue beneath skin): Burns in which both
epidermis and dermis are destroyed, with damage extending into underlying healing after 21 days or never
occur without skin grafting
Diagnosis: physical examinations, ABG, PFT (DLco will decrease), CXR (Usually normal in early stage -Pulmonary
edema/ARDS in intermediate stage- Patchy or segmental infiltrate in late stage)
Managements: 1-start with initial care of (Airway, Respiratory status, Cardiovascular status, the percentage of
body burned, Depth of burns)2- IV line for fluids and medications 3- removing the separated clothing 4-soaking
the remaining clothing before remove 5-covering the burn wound 6- infection control)
Airway management- Bronchoscopy- Hyperbaric oxygen therapy- Treatment for cyanide poisoning-Antibiotic
agents -Expectorants - Analgesic agents- Prophylactic anticoagulants.
Respiratory care treatment protocols
1- Oxygen Therapy Protocol 2- Bronchopulmonary Hygiene Therapy Protocol 3- Lung Expansion Therapy
Protocol 4- Aerosolized Medication Protocol 5- Mechanical Ventilation Protocol