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Inhalation injury increases the morbidity and mortality of burns significantly. Inhalation injury is a vague term used to describe a wide range of problems and lung airways in the context of thermal damage. Inhalation injury in 3 ways: (1) by the cells of the pulmonary parenchyma, injuries and damage caused by irritants, (2) hypoxemia by the interruption in the delivery of oxygen by asphyxiants, and (3 ) end organ damage by absorption through the respiratory tract. The heat can cause damage and the swelling of the upper airway, but uncommonly produces injuries below, except the vocal cords with steam burns. Acute asphyxia may occur due to the environment oxygen consumption by fire.
Causes
Most often, inhalation injury results from direct damage to exposed epithelial surfaces and often causes conjunctivitis, corneal edema, rhinitis, pharyngitis, laryngitis, tracheitis, bronchitis, bronchiolitis, and alveolitis. Systemic absorption of toxins also occurs. Ascertaining if respiratory insufficiency is due to direct pulmonary injury or is the result of the extensive metabolic, hemodynamic, and subsequent infectious complications of surface burns is difficult.
Symptoms
Symptoms of inhalation injury usually appear within 2 to 48 hours after the burn has occurred. Common symptoms include inhalation injuries are hemoptysis, wheezing, retching, and dyspnea. Corticosteroids are attractive to suppress the reduction of inflammation and swelling. Bronchodilators and O2 therapy may be sufficient in less serious cases. Bronchodilators intravenously may be required in severe cases. Do not feed children through the mouth until significant respiratory and hemodynamic compromise does not clearly tracheal intubation. Care in the treatment of gases and chemicals is the most important preventive measure. Systemic antibiotics are monitored cultures of sputum or transtracheal aspiration also helpful.
Treatment
Corticosteroids are attractive for suppressing inflammation and reducing edema. Controlled studies assessing their effects on various forms of chemical pneumonitis are disappointing and no direct data support their use in smoke inhalation. Because of the increased risk of infection and delayed wound healing, prolonged use of steroids is discouraged. Reports show increased incidence of pulmonary infection and mortality in steroid-treated patients. However, consider a brief course of steroids in those patients with otherwise unresponsive severe lower airway obstruction. In addition, patients receiving steroids prior to injury who may experience adrenal insufficiency should receive stress doses of steroids.
Prevention
The prevention of smoke injury is largely the prevention of fire, but if it does occur then early warning is necessary. Smoke detectors save lives, perhaps reducing fatalities by up to 60% but they only work if an effective battery is in situ and many people are lax about checking this. Even those less likely to respond so swiftly to an alarm like the very young, the elderly, the infirm and those intoxicated by drugs or alcohol may benefit
