Smoke Inhalation Injury Notes

Smoke Inhalation Injury in Burn Patients

Introduction

• Smoke inhalation injury is a significant concern in burn patients because patients exposed to fire are often exposed to smoke.
• It's a "silent threat" because airway compromise might not be immediately obvious.
• Inhalation injuries can rapidly progress to respiratory failure.

Mechanism of Injury

• Inhalation injuries occur when patients inhale smoke, hot gases, or toxic fumes.
• These inhaled substances cause damage to the airway and lungs.

Key Signs of Smoke Inhalation Injury

• Singed nasal hair: An indicator of heat exposure to the nasal passages.
• Soot in the mouth and nose: Indicates smoke exposure and deposit of carbonaceous material.
• Hoarseness or stridor: Suggests airway swelling, which can quickly become an emergency.
• Hoarseness and stridor are LATE signs of airway swelling.
• Black sputum: Indicates the presence of carbonaceous material from the lungs.
• Respiratory distress: Difficulty breathing, often manifested as shortness of breath.
• Tachypnea: Rapid breathing.
• Use of accessory muscles: Visible use of neck and chest muscles to aid breathing effort.
• Altered mental status: Can be due to carbon monoxide poisoning.

Risk Factors

• Patients with burns to the upper torso, face, and neck should always be considered at risk for smoke inhalation injury.
• It is difficult to have burns in those areas without impacting the airways.

Immediate Interventions

• Ensure the airway is clear.
• Be prepared for early intubation if signs of obstruction appear.
• Administer 100% oxygen through a non-rebreather mask to displace carbon monoxide.
• Monitor for signs of pulmonary edema or ARDS (Acute Respiratory Distress Syndrome), which may develop immediately or hours later.

Specific Considerations

• Carbon Monoxide Poisoning:

  • Confirmed through a carboxyhemoglobin level.
  • Patients may require hyperbaric oxygen therapy.

• Fluid Resuscitation:

  • Inhalation injuries significantly increase fluid resuscitation needs.
  • The burn surface area effectively increases (burn surface is not only on the outside but also in the inside of the patient).

• Monitoring:

  • Frequent respiratory and hemodynamic monitoring is essential.