Inhalation injury: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
===General=== | ===General=== | ||
* Initial signs/symptoms - | * Initial signs/symptoms - [[cough]], [[wheezing]], [[dyspnea]], irritated mucous members (runny eyes/nose), [[chest pain]], [[hypoxia]] | ||
* Specific features dependent on type of exposure | * Specific features dependent on type of exposure | ||
===Inert Gases=== | ===Inert Gases=== | ||
* Inert gases (carbon | * Inert gases (carbon dioxide, fuel gases) displace air and oxygen producing asphyxia | ||
* Present with severe hypoxia | * Present with severe [[hypoxia]] | ||
===Irritant Gases=== | ===Irritant Gases=== | ||
* Irritant gases (ammonia, formaldehyde, chlorine, nitrogen dioxide) when dissolved in water lining respiratory tract produce a chemical burn and inflammatory response | * Irritant gases ([[ammonia toxicity|ammonia]], formaldehyde, [[chlorine gas|chlorine]], nitrogen dioxide) when dissolved in water lining respiratory tract produce a [[chemical burn]] and inflammatory response | ||
* More soluble the gas produces more upper airway burns/irritation symptoms | * More soluble the gas produces more upper airway burns/irritation symptoms | ||
* Less soluble gases produce more pulmonary injury and respiratory distress | * Less soluble gases produce more pulmonary injury and [[respiratory distress]] | ||
===Systemic Toxins=== | ===Systemic Toxins=== | ||
* Includes carbon monoxide, hydrogen cyanide, hydrogen sulfide | * Includes [[carbon monoxide]], hydrogen [[cyanide]], [[hydrogen sulfide]] | ||
* Interfere with delivery of oxygen for use in cellular energy production | * Interfere with delivery of oxygen for use in cellular energy production | ||
* Liver, kidney, brain, lung and other organ damage | * Liver, kidney, brain, lung and other organ damage | ||
===Allergic=== | ===Allergic=== | ||
* Inhaled gases, particles, aerosols | * Inhaled gases, particles, aerosols | ||
* Produce bronchospasms and edema similar to asthma | * Produce bronchospasms and edema similar to [[asthma]] | ||
===[[Smoke inhalation injury|Smoke Inhalation / Thermal]]=== | ===[[Smoke inhalation injury|Smoke Inhalation / Thermal]]=== | ||
* Most fatalities from burn injuries are attributed to smoke inhalation | * Most fatalities from burn injuries are attributed to smoke inhalation | ||
* Soot in posterior pharynx, singed nasal hair | * Soot in posterior pharynx, singed nasal hair | ||
* Hyperacute - severe wheezing, bronchoconstriction, significant hypoxemia | * Hyperacute - severe [[wheezing]], [[bronchoconstriction]], significant [[hypoxemia]] | ||
* Acute pulmonary edema - onset at 48-72 hours post injury in a previously asymptomatic patient | * Acute [[pulmonary edema]] - onset at 48-72 hours post injury in a previously asymptomatic patient | ||
* | * Broncho[[pneumonia]] often at 10 days post-inury | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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* Decontaminate if not done on scene | * Decontaminate if not done on scene | ||
* Secure airway if necessary and ventilate | * Secure airway if necessary and ventilate | ||
* Oxygen at 6-12 liters per minute via mask | * [[Oxygen at]] 6-12 liters per minute via mask | ||
* Chest x-ray, pulse oximetry, arterial blood gases | * [[Chest x-ray]], pulse oximetry, arterial blood gases | ||
* Consider carboxyhemoglobin level or cyanide level if any suspicion based on history | * Consider carboxyhemoglobin level or cyanide level if any suspicion based on history | ||
* Observe for respiratory distress and airway compromise | * Observe for respiratory distress and airway compromise | ||
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* Observe for sequelae from hypoxia (myocardial infarction, cerebral injury) | * Observe for sequelae from hypoxia (myocardial infarction, cerebral injury) | ||
===Allergic=== | ===Allergic=== | ||
* Aerosolized bronchodilators | * Aerosolized [[bronchodilators]] | ||
* Corticosteroids in patients with history of reactive airway disease | * [[Corticosteroids]] in patients with history of reactive airway disease | ||
===Smoke Inhalation / Thermals=== | ===Smoke Inhalation / Thermals=== | ||
* Ensure adequate oxygenation, ventilation, pulmonary toilet and fluid resuscitation | * Ensure adequate oxygenation, ventilation, pulmonary toilet and fluid resuscitation | ||
Revision as of 19:26, 28 September 2019
Background
- Inhalational injury a concern with history of being trapped in enclosed space for some time with toxic gases / fumes
Clinical Features
General
- Initial signs/symptoms - cough, wheezing, dyspnea, irritated mucous members (runny eyes/nose), chest pain, hypoxia
- Specific features dependent on type of exposure
Inert Gases
- Inert gases (carbon dioxide, fuel gases) displace air and oxygen producing asphyxia
- Present with severe hypoxia
Irritant Gases
- Irritant gases (ammonia, formaldehyde, chlorine, nitrogen dioxide) when dissolved in water lining respiratory tract produce a chemical burn and inflammatory response
- More soluble the gas produces more upper airway burns/irritation symptoms
- Less soluble gases produce more pulmonary injury and respiratory distress
Systemic Toxins
- Includes carbon monoxide, hydrogen cyanide, hydrogen sulfide
- Interfere with delivery of oxygen for use in cellular energy production
- Liver, kidney, brain, lung and other organ damage
Allergic
- Inhaled gases, particles, aerosols
- Produce bronchospasms and edema similar to asthma
Smoke Inhalation / Thermal
- Most fatalities from burn injuries are attributed to smoke inhalation
- Soot in posterior pharynx, singed nasal hair
- Hyperacute - severe wheezing, bronchoconstriction, significant hypoxemia
- Acute pulmonary edema - onset at 48-72 hours post injury in a previously asymptomatic patient
- Bronchopneumonia often at 10 days post-inury
Differential Diagnosis
Inhalation injury
- Unintentional
- Terrorism
- Pulmonary chemical agents
- Ammonia
- Methyl isocyanate
- methyl bromide
- Hydrochloric acid
- Chlorine
- Phosgene
- Bioterrorism
Burns
- Smoke inhalation injury (airway compromise)
- Chemical injury
- Acrolein
- Hydrochloric acid
- Tuolene diisocyanate
- Nitrogen dioxide
- Systemic chemical injury
- Specific types of burns
- Associated toxicities
Evaluation
- Look for evidence of exposure
- Estimated time of exposure
- Open or enclosed space
- Associated events such as fire, blast, etc.?
- Is the exposure known?
- Material on patient? Does patient smell of chemical?
- Examples - smoke inhalation from burning building, leak of a solvent, chemical fumes
- Physical examination with focus on airway and pulmonary system
- Observe of evidence of airway compromise or respiratory distress
Management
General
- Separate patient from fumes/toxic agent
- Decontaminate if not done on scene
- Secure airway if necessary and ventilate
- Oxygen at 6-12 liters per minute via mask
- Chest x-ray, pulse oximetry, arterial blood gases
- Consider carboxyhemoglobin level or cyanide level if any suspicion based on history
- Observe for respiratory distress and airway compromise
Inert Gases
- Remove victim from the gas
- Fresh air or oxygen
- Observe for sequelae from hypoxia (myocardial infarction, cerebral injury)
Allergic
- Aerosolized bronchodilators
- Corticosteroids in patients with history of reactive airway disease
Smoke Inhalation / Thermals
- Ensure adequate oxygenation, ventilation, pulmonary toilet and fluid resuscitation
Disposition
- Respiratory distress or airway compromise will need admission
- Observe for 1-4 hours if no signs or symptoms of inhalation injury develop or if all resolved within 1 hour consider discharging patient home with instructions for return for re-evaluation next day or sooner if pulmonary and/or airway symptoms develop
See Also
External Links
Video
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