Inhalation InjuryArek Wiktor M.D.
University of Colorado Hospital OutlineBackground
Specific Lethal Compounds
http://spanishlakefd.com/firealarms/ Learning ObjectivesDescribe the pathophysiology of inhalation injury
How is inhalation injury diagnosed?
What adjunctive measures are used to treat inhalation injury?
What is the treatment for carbon monoxide and cyanide poisoning? A Sunday afternoon stroll thru the fire…http://www.aeromedix.com/product-exec/parent_id/1/category_id/12/product_id/1074/nm/Safe_Escape_Smoke_Hood Epidemiology15-30% of burn admissions have inhalation injury
Independent predictor of mortality, ↑ by 20%
Increases pneumonia risk
Leading diagnosis of those hospitalized and treated on 9/11, World Trade Center attack Anatomic ClassificationUpper airway
Systemic toxicityhttp://www.monroecc.edu/depts/pstc/backup/parasan4.htm SMOKEVariable, changes with time burning
Toxic gases and low ambient oxygen
Aldehydes (formaldehyde, acrolein), ammonia, hydrogen sulfide, sulfur dioxide, hydrogen chloride, hydrogen fluoride, phosgene, nitrogen dioxide, organic nitriles
Particulate matter Prien et al. Burns 1988; 14:451-460 PathophysiologyCilia loss, respiratory epithelial sloughing
Atelectasis, occlusion by debris/edema
Bacterial colonization at 72 hrsHubbard et al. J Trauma 1991; 31:1477-1486 Bartley et al. Drug Design, Development and Therapy. 2008; 2: 9–16. Secondary Lung InjuryUnilateral smoke inhalation damages contralateral lung
Immune response, increased permeability
Oxygen-derived free radicals
NO mediated damage (chemotactic factor neuts)
Reduced phagocytosis in macrophages ...