Thanks to Dr. Muhlfelder for today’s Morning Report!
Inhalant Injuries
Initial Mgmt: ABCs, IV, oxygen supplementation, monitor
Exam: bronchospasm, airway edema, nares +/- thermal injury
- initial eval of airway is not good predictor of progressing edema/compromise, progresses over 24-72 hours
- bronchopulmonary injury + cutaneous burns >30%BSA increases mortality to >70%
Common exposures/metal fumes: nitrogen oxides, cyanide, zinc, chlorine gas, ammonia, phosphorus, sulfur trioxides, Teflon
Immediate concern: reverse cellular asphyxia, CO and cyanide tox
Dispo:
- Mild exposure: 4-6 hr observation, supplemental oxygen, nebulizers
- Admission:
- closed-space exposure x 10 min+
- carbonaceous sputum production
- arterial p02 under 60mmHg
- metabolic acidosis
- COhgb >15%
- bronchospasm
- central facial burns
Indication for HBO:
- CO tox w neuro abnml +LOC, profound acidosis, MI
- CO>25%, or >15% in pregnancy (fetal hgb binds co more tightly)
- Pulmonary edema
CO: causes tissue hypoxia by decreasing 02carrying capacity, hgb affinity x200 v 02, reduced 02 unloading, encephalopathy occurs 2/2 reperfusion injury w lipid peroxidation and free radical damage. Abnml exposure= >3%, >10% in smoker
CN: halts cellular respiration causing anaerobc metabolism and lactic acidosis
Zinc: decreased TLC, VC and CO diffusion leading to pulmonary edema, decreased compliance, increased airway resistance
Metal Fume Fever: fever, myalgias, headache, weakness, and nausea developing after 4-12 hrs s/p exposure. Self resolves within 2 days.
Complications: bronchiectasis, subglottic stenosis, PE, pneumonia, atelectasis, exacerbation of pre-existing respiratory dz (asthma, COPD)
Jay Khadpe MD
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