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Disease 2 > Inhalation Injury > Flashcards

Inhalation Injury Flashcards

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1
Q

Describe inhalation injury

A

A nonspecific term for damage to the respiratory tract or lung tissue from heat, smoke or chemical irritants that were carried into the airway during inspiration

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2
Q

Describe a burn injury

A

Traumatic injury to tissues caused by thermal or other acute exposures to heat, electrical discharge, friction, chemicals or radiation

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3
Q

What factors should be considered when dealing with inhalation injuries?

A

Duration of exposure
Chemical composition of the smoke
Size of particles in smoke
Temperature of the gas inhaled
Age
PMH
Size and depth of body surface burns

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4
Q

What are the two kinds of smoke?

A

Pyrolysis = smoldering, low oxygen
Combustion = burning with visible flame, adequate oxygen

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5
Q

What are the two most common gasses inhaled in smoke?

A

Carbon monoxide
Hydrogen cyanide

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6
Q

What is the main concern with severe burn injuries?

A

Loss of protective barrier between the patient and the outside world

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7
Q

What is the common rule for estimating the percentage of BSA that has been burned?

A

Rule of 9s

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8
Q

On an adult, describe the percentage of the body associated with the head, torso, arms and legs

A

Head = 9
Arm = 9 each
Torso = 36 (front is 18, back is 18)
Legs = 18 each

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9
Q

On a child, describe the percentage of the body associated with the head, torso, arms, and legs

A

Head = 21
Arms = 9 each
Torso = 36 ( 18 for front, 18 for back)
Legs = 12 each

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10
Q

What populations are most at risk from dying as a result of severe burns?

A

Elderly
Infants

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11
Q

Which layer of skin do first degree burns involve?

A

Only the epidermal layer

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12
Q

Describe how 1st degree burns present

A

Do not blister
Painful, dry and red
Blanch with pressure

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13
Q

What is the recovery time for 1st degree burns?

A

Pain usually subsides in 2-3 days
Usually healed in about 6 days
Epidermis peels away without scarring

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14
Q

What layers of skin do partial thickness burns involve?

A

Epidermis and part of dermis

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15
Q

How are partial thickness burns classified?

A

Superficial or deep

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15
Q

What is another term for partial thickness burn?

A

Second degree burn

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16
Q

Describe how superficial partial thickness burns present

A

Painful
Red
Weeping
Blanch with pressure
Blister within 24 hours

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17
Q

What is the recovery time for superficial partial thickness burns?

A

Generally heal in 7-21 days

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18
Q

What layers of the skin do deep partial thickness burns involve?

A

Epidermis and dermis
Damage hair follicles and glandular tissue

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19
Q

What do deep partial thickness burns look like?

A

Painful only to pressure
Mottled coloration, patchy, cheesy white to red
Will cause scarring

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20
Q

How long do deep partial thickness burns take to heal?

A

Greater than 21 days, frequently require surgical intervention

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21
Q

What layers of the skin are affected by full thickness burns?

A

All layers of the dermis
Often damage subcutaneous tissue

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22
Q

What do full thickness burns look like?

A

Waxy white or leathery gray
Burn eschar (burned skin) present and variously colored

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23
Q

Describe the texture of a full thickness burn

A

Surface is dry
Inelastic
Does not blanch to pressure

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24
Describe the healing time associated with full thickness burns
Burn will probably never heal on its own, will require surgery
25
What protects the lower respiratory tract from the heat carried by inhaled gases?
Ability of upper respiratory tract to absorb heat Reflex laryngospasm Glottic closure
26
How might a patient with a thermal injury to their respiratory tract present?
Pharyngeal edema Stridor Hoarseness Painful swallowing
26
What can thermal injuries to the upper airway cause?
Blistering Mucosal edema Vascular congestion Epithelial sloughing Accumulation of thick secretions
27
Why is steam inhalation particularly dangerous?
Can carry 500x more heat than dry gas Inhalation of steam usually results in severe damage to all levels of the respiratory tract
28
What can thermal injuries to the distal airways cause?
Mucosal edema Vascular congestion Epithelial sloughing Cryptogenic organizing PNA Atelectasis Pulmonary edema
29
Describe how an airway presents in the early stage post smoke inhalation
Tracheobronchial tree becomes inflamed Bronchospasm Excess bronchial secretions
30
Why are secretions difficult for smoke inhalation victims to clear?
Irritants and toxins in the smoke inhibit the movement of the cilia preventing mucus clearance
31
What must be taken into consideration if a patient has burns around the neck and face?
That swelling from the injury may put pressure on the airway
31
Burn victims can often enter a state of hypovolemic shock. Explain how this happens
Fluid loss through burned skin Inflammatory mediators provoke vascular permeability so fluid enters the interstitial/third space
32
What could cause cardiogenic shock in burn victims?
Hypovolemia Hypoxia Increased SVR + PVR Carbon monoxide poisoning
33
What are the risks associated with circumferential burns?
On extremities = impaired circulation and tissue necrosis On chest and abdomen = reduced chest wall compliance and increased WOB
34
Describe what happens to the upper airways during the intermediate stage after inhalation injury?
Upper airway injuries usually improve
35
What happens to the lower airways in the intermediate stage after inhalation injury?
Deteriorate Increased mucus production Mucociliary transport continues to decrease Mucosa of tracheobronchial tree becomes necrotic and sloughs off
36
The continued compromise of the mucociliary transport and the sloughing of the tracheobronchial mucosa leads to what?
Mucus plugging and atelectasis
37
Why are inhalation injury victims at high risk for developing bronchitis and pneumonia?
Mucus accumulation due to compromised mucociliary transport results in bacterial colonization
37
Why are burns to the chest wall particularly concerning from a respiratory perspectiv
Inhibit deep breathing and coughing
38
What are the late stage problems associated with smoke inhalation?
Infections on body surface Pneumonia PE Restrictive and obstructive lung disorders
39
What can infections on the body surface of burn victims lead to?
Systemic inflammatory response syndrome (SIRS)
40
What is the primary cause of death in burn patients during the late stage?
Sepsis induced SIRS
40
Why do burn victims have an increased risk for a pulmonary embolism?
They are immobilized and at risk for deep venous thrombosis and hypercoagulability
41
Why is carbon monoxide such a problem?
CO has an affinity for hemoglobin that is 210x greater than for oxygen Hemoglobin will load CO instead of oxygen causing hypoxia
41
Why is it difficult to detect CO poisoning?
If using a pulse oximeter, the device will register a high SpO2 but it will not be able to discern between hgb loaded with oxygen and hgb load with CO
42
How will a patient with mild CO poisoning present?
Mild headache Cherry red skin (possibly)
42
How will a patient with moderate CO poisoning present?
Throbbing headache Nausea, vomitting Impaired judgement
43
How will a patient with severe CO poisoning present?
Syncope Increased HR and RR Coma Convulsions Cheyne stokes
44
What is the risk associated with inhaled cyanide?
Will prevent the body from being able to use oxygen to produce ATP resulting in anaerobic metabolism which increases the bodys pH SpO2 and PaO2 will look normal, but body will be unable to use oxygen
45
Describe how a victim caught in a fire could suffer from a triple threat of hypoxia
Hypoxic hypoxia = fire uses all available oxygen Histotoxic hypoxia = carbon monoxide poisoning prevents oxygen loading Histotoxic hypoxia = cyanide prevents the body from using oxygen
46
When evaluating a patient and you suspect smoke inhalation, what signs would you look for?
Singed nasal hair Soot it nares Soot in upper airway Oral and laryngeal edema Cyanosis
47
A patient who is suspected to have inhaled smoke is coughing. Describe what kind of sputum would confirm the suspicions of smoke inhalation
Carbonaceous sputum
48
How do you confirm a diagnosis of smoke inhalation?
Patient history Visual inspection of airway Bronchoscopy
49
What would the PFT of smoke inhalation patient look like?
Decreased flows Decreased volumes Decreased capacities
50
Describe how a CXR would look for a smoke inhalation patient in the early, middle and late stages
Early = normal Intermediate = pulmonary edema or ARDS Late = patchy of segmental infiltrates
51
What carboxyhemoglobin level would indicate carbon monoxide poisoning?
COHb> 20%
52
What carboxyhemoglobin level would indicate severe carbon monoxide poisoning?
Approaching 40%
53
A COHb if >50% may have what effects?
Lasting damage to the nervous system
53
Why should the airway of smoke inhalation victims be checked frequently?
Development of Upper airway edema Blisters Thick secretions Stridor
54
When intubating patients, what size tube should be favored and why?
8.0-8.5 Allows for bronchoscopy for diagnostics and interventions
55
What strategies should be employed to prevent infection in burn victims?
Reverse isolation precautions Positive pressure rooms Air filtration Wound coverings
56
What are options for treating CO poisoning?
Hyperbaric oxygen if patient is stable High flow nasal cannula If face is burned, NIV can be difficult
57
How is cyanide poisoning treated?
Cyanokit aka hydroxocobalamin IV
58
What medications are given via aerosol to smoke inhalation victims?
Heparin every 4 hours 20% NAC
59
What does heparin do for smoke inhalation victims?
Reduces the formation of heparin casts in the airways Scavenge for reactive oxygen species
60
What does NAC do for smoke inhalation victims?
Mucolytic Prevent cast formation Scavenge for reactive oxygen species
61
How are secretions in burn victims managed?
Bronchoscopy to provide suction Intrapulmonary percussive ventilation

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