Inhalation injury Helena Croft JAHD 1st May 2012 contents • • • • • What is inhalation injury Mechanism of injury Treatment Prognosis 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 Pathophysiology • Oedema – progressive ranging from mild to serve and associated with cast formation. • Decreased pulmonary compliance • Inactivation of surfactant • Destruction of cilia • Risk of ARDS assessment Management • • • • • • Resuscitation – fluids, high flow O2 Airway management – possible intubation ventilation 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 bronchodilator 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 visits Patient/family education regarding inhalation injury The protocol is continued for 7 days.