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Inhalation injury

Inhalation injury. Helena Croft JAHD 1 st May 2012. contents. What is inhalation injury Mechanism of injury Treatment Prognosis Research summary. Present in 10-30% of burns cases 75% of burns related deaths Delayed presentation Most common in under 5’s and over 75’s

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Inhalation injury

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  1. Inhalation injury Helena Croft JAHD 1st May 2012

  2. contents • What is inhalation injury • Mechanism of injury • Treatment • Prognosis • Research summary

  3. Present in 10-30% of burns cases • 75% of burns related deaths • Delayed presentation • Most common in under 5’s and over 75’s • Risks – enclosed space, increased time, underlying respiratory disease.

  4. Mechanisms of injury • Thermal damage - upper airways - obstructive pattern in first 12 or so hours • Asphyxiation – CO higher affinity for Hb - disassociation curve shifts to the left worsening tissue hypoxia, • Irritation - damage to parenchyma - products of incomplete combustion

  5. Pathophysiology • Oedema – progressive ranging from mild to serve and associated with cast formation. • Decreased pulmonary compliance • Inactivation of surfactant • Destruction of cilia • Risk of ARDS

  6. assessment

  7. Management • Resuscitation – fluids, high flow O2 • Airway management – possible intubation • ventilation • Chest physio • Pharmacological agents • Management of late complications

  8. Titrate humidified oxygen to maintain SaO2s’ > 90% Cough, deep breath exercises every 2 h Turn patient side to side every 2 h Chest physiotherapy every 4 h Aerosolize 3 cc’s of 20% N-acetylcysteine every 4 h with a bronchodilator Alternate aerosolizing 5000 units of Heparin with 3 cc’s of normal saline every 4 h Nasotracheal suctioning as needed Early ambulation on post-operative day 5 Sputum cultures for intubated patients every Monday, Wednesday, Friday Pulmonary function studies prior to discharge and at out-patient visits Patient/family education regarding inhalation injury The protocol is continued for 7 days.

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