The
burn patient undergoes a number of dramatic physiologic
and metabolic changes over the course of the injury
state. These changes are so marked that the physician
may have the feeling of treating a different patient
every several days as the process evolves. It is
essential to have a clear understanding of the
pathophysiologic differences and the necessary treatment
modifications needed over time following the burn. To
help clarify this process, the burn injury is divided
into the following phases. The pulmonary problems
specific to each phase will be discussed.
- Resuscitation
phase (0 to 36 hours)
- Post
resuscitation phase (2 to 6 days)
- Inflammation,
infection phase (7 days to wound closure)
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INITIAL
AIRWAY AND PULMONARY ABNORMALITIES
Resuscitation
phase
Abnormalities
of ventilation and oxygenation are a common finding in
the immediate post burn period. There are four fairly
distinct critical disease processes that must be
recognized and aggressively managed. The first three are
associated with the inhalation injury complex and are
presented in the approximate order in which symptoms
will develop.
A
respiratory reference section is provided as an appendix
to assist in the monitoring and support of lung function
during all phases of lung injury.
AIRWAY,
PULMONARY, TISSUE OXYGENATION ABNORMALITIES
- Carbon
Monoxide and Cyanide toxicity
- Upper
airway obstruction
- Chemical
burn to the lung
- Impaired
chest wall compliance
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SMOKE
INHALATION INJURY COMPLEX
Pulmonary
insufficiency caused by the inhalation of heat and smoke
is the major cause of mortality in the fire-injured
person, accounting for more than 50% of fire-related
deaths. The magnitude of the problem has been much
better appreciated in recent years. The use of many new
synthetics in home furnishings and clothing have
resulted in a much more complex form of injury, due to
the extremely toxic combustion products of these
advances in technology. A closed space fire can result
in a severe hypoxic insult as well as lung damage from
the inhalation of toxic fumes. The exposure time, the
concentration of fumes, the elements release, and the
degree of concomitant body burn are critical variables.
These factors cause a very complex injury with morbidity
and mortality risks, especially when combined with a
body burn. Improved knowledge of the pathophysiology
combined with an aggressive treatment plan has made it
possible to improve the outcome.
Click
to Enlarge the Image
Smoke
inhalation complex - 12 hrs post-burn
(Edema, carbon particles in nares and airways)
THREE
TYPES OF SMOKE INHALATION
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CARBON
MONOXIDE
INTOXICATION
-
INHALATION
INJURY ABOVE THE GLOTTIS
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INHALATION
INJURY BELOW
THE GLOTTIS
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