1. Inhalation injury Helena Croft JAHD 1 st 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.