Inhalational Injury 

 

 

Considerations

 

  • Emergency/full stomach 

  • Airway swelling & potential for airway obstruction 

  • Tracheobronchial thermal & chemical injury resulting in pulmonary complications:

    • Alveolar collapse/atelectasis & airway plugging 

    • Bronchospasm

    • Pneumonia

    • ALI/ARDS  

  • Carbon monoxide & cyanide poisoning 

  • General burn considerations:

    • Hypovolemic shock

    • Hypo or hyperthermia

    • Rhabdomyolysis

    • Cardiac depression

    • DIC, consumptive coagulopathy

 

 

Management 

 

  • Secure airway early if compromised 

  • Bronchoscopy to document degree of tracheobronchial injury 

  • Use lung protective ventilation strategies:

    • Tidal volume ≤ 6cc/kg 

    • Plateau pressure < 30cm H2O

    • PEEP & FiO2 to achieve adequate oxygenation (PaO2 ≥55 to 80 mmHg) 

  • Start burn resuscitation 

  • Rule out & treat carbon monoxide & cyanide poisoning 

  • ICU admission & monitoring