T8 Inhalation Burns and Fumes

• What are burns?

  Injury to skin or other tissues caused by heat, chemicals, electrical current, or radiation.
• Are most burn accidents preventable?

  Yes.
• What problem may someone have after being exposed to smoke?

  Gas exchange.
• What kind of fluid issues would someone have after a burn?

  Fluid and electrolyte imbalances.
• What kind of burns can alter perfusion to limbs?

  Full-thickness.
• What are patients with burns at risk for?

  Malnutrition and immobility.
• What is a constant threat with burns?

  Infection.
• What are thermal burns?

  Exposure to external heat sources like hot metals, scalding liquids, steam, or flames.
• What does the severity of a thermal burn depend on?

  Temperature of the agent and duration of skin contact.
• What is the most common type of burn injury?

  Thermal burns.
• What kind of problems may a burn on the face, neck, and circumferential torso cause?

  Gas exchange due to leathery eschar, edema.
• What kinds of problems may occur with a burn on the hands, feet, and joints?

  Mobility and function limitations.
• What kind of problems may occur with a burn on the ears, nose, buttocks, and perineum?

  High risks for infections.
• What can contribute to poorer prognoses for thermal burns?

  Preexisting heart conditions, lung, or chronic diseases.
• Diabetes and peripheral vascular disease put a patient at high risk for what after a thermal burn?

  Delayed healing.
• What are the three types of inhalation injuries?

  • Metabolic asphyxiation
  • Upper airway injury
  • Lower airway injury
• What is metabolic asphyxiation?

  Injury from exposure to toxic gases including carbon monoxide and/or cyanide.
• What is an upper airway injury?

  Above the glottis injury from direct heat or chemicals causing severe mucosal edema.
• What is a lower airway injury?

  Below the glottis injury causing airway inflammation and edema resulting in edema, atelectasis, and pneumonia.
• How does carbon monoxide (CO) poisoning work?

  CO displaces oxygen on hemoglobin.
• What can CO displacing oxygen cause?

  Hypoxia, carboxyhemoglobinemia, death.
• When does death occur with CO poisoning?

  When CO levels are 20% or higher.
• Does a standard pulse oximeter distinguish oxyhemoglobin or carboxyhemoglobin?

  No.
• For someone suspected or confirmed for CO poisoning, what hsould be applied to them?

  Pulse CO oximetry (SpCO).
• How do you treat CO poisoning?

  100% humidified oxygen.
• CO poisoning can happen with or without burn injuries to skin.
• Where are upper airway injuries?

  Injuries to the mouth, oropharynx, and/or larynx.
• How do upper airway injuries occur?

  Thermally produced, hot air, steam, smoke.
• Swelling in an upper airway injury may be massive and have a rapid onset.
• What can compromise breathing in an upper airway injury?

  Eschar and edema.
• Swelling from scald burns can be lethal with an upper airway injury.
• What are signs of mucosal burns of the oropharynx and larynx?

  Redness, blistering, edema.
• What are reliable clues to upper airway injuries?

  • Facial burns
  • Singed nasal hair
  • Hoarseness, painful swallowing
  • Darkened oral and nasal membranes
  • Carbonaceous sputum
  • History of burns in an enclosed space
  • Clothing burns around neck and chest
• What is a lower airway injury?

  Injury to trachea, bronchioles, and alveoli.
• What may not appear until 12 - 48 hours after a burn with a lower airway injury?

  Pulmonary edema manifesting as acute respiratory distress syndrome (ARDS).
• What is important to know regarding respiratory management after smoke inhalation injuries?

  • Fiberoptic bronchoscopy diagnostic and carboxyhemoglobin levels
  • Check sputum for carbon particles
  • Watch for signs of respiratory distress
  • Patients with preexisting lung disease are more likely to develop a respiratory infection
• How can airway be managed for smoke inhalation injuries?

  • High Fowler's position
  • Medications
  • Deep breathing, coughing, repositioning
  • Suctioning
  • ABG's, telemetry, pulse oximetry, capnography
  • Early endotracheal intubation
• What medications are used for smoke inhalation injuries?

  100% oxygen, aerosolized heparin, N-acetylcysteine, albuterol.
• What immunization is given routinely to all burn victims?

  Tetanus.
• When should tetanus immunoglobulin be considered?

  If the patient has not received an active immunization within the last 10 years.