Các tổn thương do hít khói

0 No injury No carbonaceous deposits, erythema, edema, bronchorrhea, obstruction. 1 Mild Minor patchy areas of erythema, deposits in proximal or distal bronchi[r]

Inhalation Injuries

Shaila DeLea DO PGY2 Maine Medical Center Department of Emergency Medicine

Portland, Maine, USA

Simple Asphyxiants

• Non toxic/minimally toxic gas

• Nitrogen, argon, helium, butane, propane

• Inert and odorless

• Displaces oxygen and lowers inhaled fraction of oxygen

• Acute effects in minutes due to hypoxia

• Removal from gas resolves hypoxia

• Supportive care

Pulmonary Irritants

• Environmental exposure

• Direct cellular toxicity

• Effects based on water

Low

Upper airway

swelling

Chemical IntoxicationAcute Respiratory

Failure

Upper Airway Injury

• Thermal injury

• Airway swelling

• Ciliary damage

Lower Airway Injury

Systemic Toxicity

History and Physical

• Chemical vs smoke vs flame

• Duration

• Loss of consciousness

• Enclosed space

Signs & Symptoms

Low Risk Patients

LOW RISK Monitor 4-6 hours

HOSPITALIZE ANY RED FLAGS

Airway Management

• Humidified oxygen

• NIPPV

• Assume CO poisoning

Extracorporeal membrane oxygenation

• Indicated for severe respiratory or cardiac failure

• Must be reversible and

Bronchoscopy

Abbreviated Injury Score (AIS)

Score Class Description

bronchorrhea, obstruction

distal bronchi

carbonaceous deposits

Summary

• Burn + Pulmonary injury = increased mortality

• Early death is due to hypoxia, airway compromise, metabolic derangements

• Secure the airway early!

• Always consider CO and cyanide poisoning

• Bronchoscopy is both therapeutic and diagnostic

• Good pulmonary care improves outcomes

• Consider ECMO if not responding to conventional management