Inhalation injury

Inhalation injury
Helena Croft
JAHD 1st May 2012
What is inhalation injury
Mechanism of injury
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 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
• Oedema – progressive ranging from mild to serve
and associated with cast formation.
• Decreased pulmonary compliance
• Inactivation of surfactant
• Destruction of cilia
• Risk of ARDS
Resuscitation – fluids, high flow O2
Airway management – possible intubation
Chest physio
Pharmacological agents
Management of late complications
Titrate humidified oxygen to maintain SaO2s’ > 90%
Cough, deep breath exercises every 2 h
Turn patient side to side every 2 h
Chest physiotherapy every 4 h
Aerosolize 3 cc’s of 20% N-acetylcysteine every 4 h with a
Alternate aerosolizing 5000 units of Heparin with 3 cc’s of
normal saline every 4 h
Nasotracheal suctioning as needed
Early ambulation on post-operative day 5
Sputum cultures for intubated patients every Monday,
Wednesday, Friday
Pulmonary function studies prior to discharge and at outpatient
Patient/family education regarding inhalation injury
The protocol is continued for 7 days.