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inhalation injury
Etiology:
- smoke, fire, burns
- other noxious or toxic gases
Clinical manifestations:
- inhalation injury affecting the lung manifests 12-36 hours after exposure
- wheezing, cough, dypnea
Laboratory:
- assess for carbon monoxide poisoning
- carboxyhemoglobin in blood
- carbon monoxide in breath
- assess for cyanide poisoning
- a normal serum LDH excludes cyanide poisoning
- cyanide in blood or cyanide in serum
- normal SaO2 does not exclude carbon monoxide poisoning &/or cyanide poisoning
Radiology:
- chest X-ray generally clear
Complications:
- 50% of deaths associated with burns are due to complications of inhalation injury
- difficult to predict which patients with non-obstructing oropharyngeal edema will develop complete airway obstruction [1]
- tracheobronchial injury increases risk of
- airway necrosis
- mucosal sloughing
- bleeding
- copious secretions
- atelectasis
- pneumonia
- acute respiratory distress syndrome
Management:
- 1st priority is to ensure airway patency
- may include:
- endotracheal intubation & mechanical ventilation
- bronchoscopy for debridement & sunctioning
- intravenous fluids
- antibiotics
- chest physiotherapy
- not useful
- heliox may be useful in cases of increased airway resistance but does not have a role in inhalation injury [1]
- inhaled epinephrine & other bronchodilators for bronchospasm & upper airway edema due to allergic reactions or anaphylaxis but do not have a role in inhalation injury [1]
- glucocorticoids do have a role in inhalation injury [1]
- treat carbon monoxide poisoning &/or cyanide poisoning
Related
burn
smoking; cigarette smoking; tobacco smoking
General
respiratory tract disease
References
- Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 19.
American College of Physicians, Philadelphia 2012, 2015, 2022.
- Medical Knowledge Self Assessment Program (MKSAP) 19
Board Basics. An Enhancement to MKSAP19.
American College of Physicians, Philadelphia 2022
- Walker PF, Buehner MF, Wood LA et al
Diagnosis and management of inhalation injury: an updated review.
Crit Care. 2015 Oct 28;19:351. Review.
PMID: 26507130 Free PMC Article