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
• 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
  • inhaled epinephrine & other bronchodilators for bronchospasm & upper airway edema due to allergic reactions or anaphylaxis but do not have a role in inhalation injury
  • glucocorticoids do have a role in inhalation injury
• treat carbon monoxide poisoning &/or cyanide poisoning

More general terms

• respiratory tract disease

Additional terms

• burn
• smoking; cigarette smoking; tobacco smoking