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  • • Major cause of death after burns is respiratory tract injury or complications in the respiratory tract

    Problems include:

    • -Inhalation injury


      -Bacterial pneumonia

      -Pulmonary edema

      -Pulmonary embolism

      -Post-traumatic pulmonary insufficiency

    • Direct inhalation injuries are divided into 3 categories

    • 1. Heat injury to the airway

      2. Carbon monoxide poisoning

      3. Inhalation of noxious gases

    Heat injury is a rare cause of injury below the vocal cords because the upper airway effectively cools the inspired gases and reflexive closure of the cords halts full inhalation

    • -Acute edema of the upper tract may cause airway obstruction and asphyxiation without lung damage

      -Treatment is primarily supportive with pulmonary toilet, mechanical ventilation (as needed), and antibiotics

    Carbon monoxide poisoning must be considered in every patient in whom inhalation injury is suspected

    • -ABG and carboxyhemoglobin levels must be measured

      -COHgb levels > 5% in nonsmokers and > 10% in smokers indicates carbon monoxide poisoning

      -Mild carbon monoxide poisoning (< 20% COHgb) is manifested by headache, slight dyspnea, mild confusion, and diminished visual acuity

      -Moderate carbon monoxide poisoning (20-40% COHgb) leads to irritability, impairment of judgement, dim vision, nausea, and fatigability

      -Severe carbon monoxide poisoning (40-60% COHgb) produces hallucinations, confusion, ataxia, collapse, and coma

      -Levels in excess of 60% COHgb are usually fatal

    Toxic inhalation of different chemicals produces specific respiratory injuries

    • -Inhalation injury causes severe mucosal edema followed soon by sloughing of the mucosa

      -The destroyed mucosa in the larger airways is replaced by a mucopurulent membrane

      -Edema fluid enters the airway and, when mixed with the pus, may form casts and plugs in the smaller bronchioles

    • Less common causes of respiratory failure are pulmonary embolus and overload pulmonary edema

    Pulmonary emboli usually occur later in the course of treatment after prolonged bed rest and should be suspected if respiratory function suddenly deteriorates

    Pulmonary edema usually occurs only in patients with preexisting heart disease

    • Probably the most common cause of respiratory failure is bacterial pneumonia due to either inhalation injury, contamination of the lungs through a tracheostomy or endotracheal tube, airborne infection, or hematogenous spread of bacteria from the burn wound

    • Alteration of oropharyngeal normal flora with colonization by pathogens and subsequent aspiration of infected secretion is the most common cause of the lung infections

    Pulmonary insufficiency is associated with systemic sepsis; differentiating acute respiratory distress syndrome (ARDS) from bacterial pneumonia may be difficult

Symptoms and Signs

  • • Airway erythema

    • Airway edema

    • Stridor

    • Dyspnea

    • Carbonaceous sputum

Laboratory Findings

  • • Hypoxemia

    • Carboxyhemoglobinemia

    • Bacterial cultures

Imaging Findings

  • Chest film: Edema, pneumonia, ARDS, etc.

  • • Must also evaluate for skin burns and blunt trauma (falls)

  • • ABG measurement

    • Carboxyhemoglobin measurement

    • Direct laryngoscopy is probably as helpful as fiberoptic laryngoscopy

    • Fiberoptic laryngoscopy can detect injury but is not quantitative

    • ...

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