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Acute Inhalation Injury

Acute Inhalation Injury. Types of inhaled substances. Gas Aerosol Vapor Fume Mist smoke. Properties of irritants. Gas (water solubility) High water solubility: ammonia, SO2,HCL Immediate injury to upper airway person quickly leave area low water solubility: Phosgene, ozone, NOX

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Acute Inhalation Injury

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  1. Acute Inhalation Injury

  2. Types of inhaled substances • Gas • Aerosol • Vapor • Fume • Mist • smoke

  3. Properties of irritants • Gas (water solubility) • High water solubility: ammonia, SO2,HCL • Immediate injury to upper airway • person quickly leave area • low water solubility: Phosgene, ozone, NOX • Injury of terminal bronchiole & alveolus • person remain in area • Intermediate water solubility:chlorine

  4. Properties of irritants • Particle (size)

  5. Classification of injury

  6. Acid (chlorine, HCL,SO2, NOX, phosgene) • coagulation • Alkali (ammonia) • liquefaction • Reactive o2 species(ozone, NOX, chlorine) • Lipid peroxidation

  7. Upper airway injury • Path physiology • Direct contact & tissue damage • Direct smooth muscle contraction • Stimulation of neuronal receptors • Influx of inflammatory cells & mediators • Leakage of interstitial fluid & edema • Decrease epithelium,s barrier function

  8. Upper airway injury- presentation • Burn of skin, eyes, nasal & throat • Rhinitis • Conjunctivitis • lacrimation • Sputum production • Coughing & sneezing • Airway obx • tissue edema, thick secretion, sloughed cells • Laryngospasm • hoarseness ,stridor

  9. Upper airway injury - Management • Removal from exposure • Irrigation with large amount of water • Suction of secretion • O2 if hypoxemia • Airway obx • Inhaled epinephrine • Endotracheal intubation • Tracheotomy • Corticosteroids • No influence • Extensive edema: suggested • Management of Skin & mucosal surface burns • Ophthalmologic consultation

  10. Conductive airway • Acute • Tracheobronchitis & bronchorrhea • Hospitalization for observation • Asymptomatic person+ objective evidence of respiratory compromise • Airflow • O2sat • Abnormal CXR • Asymptomatic person+ history of intense exposure • With respiratory symptoms

  11. Conductive airway • Baseline spirometry: repeat after 24-48h • Significant decrement: • FEV1≤80% • Decrease ≥ 10% from baseline

  12. Conductive airway • Symptomatic person without decrement in airflow • Inhaled steroid +bronchodilator • Symptomatic person with airflow obx • Short course of systemic steroids AND • Inhaled steroid +bronchodilator

  13. Conductive airway( chronic) • COPD • RADS

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