TY  - CHAP
M1  - Book, Section
TI  - Burns, Respiratory Injury
A1  - Doherty, Gerard M.
PY  - 2010
T2  - Quick Answers Surgery
AB  - •  Major  cause  of  death  after  burns  is  respiratory  tract  injury  or  complications  in  the  respiratory  tract•  Problems  include:-Inhalation  injury-Aspiration-Bacterial  pneumonia-Pulmonary  edema-Pulmonary  embolism-Post-traumatic  pulmonary  insufficiency•  Direct  inhalation  injuries  are  divided  into  3  categories1.  Heat  injury  to  the  airway2.  Carbon  monoxide  poisoning3.  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  
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PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2024/04/18
UR  - accesssurgery.mhmedical.com/content.aspx?aid=58104963
ER  -