Acute inhalation injury

The inhalation trauma refers to a chest trauma due to inhalation of corrosive, toxic, hot or cryogenic gases or aerosols. This may lead to damage of the upper and lower respiratory tract and the lung. The cause of the trauma There are three forms:

• The thermal inhalation trauma
• The chemical inhalation trauma
• The toxic inhalation trauma

The thermal inhalation trauma

In thermal inhalation trauma it comes to inhalation of hot gases, such as fires or explosions or cold gases by inhalation of aerosols released cryogenic liquids and substances such as liquid nitrogen.

With the release of low-temperature gases form in the ambient air aerosol clouds of liquid gas. These cause a freezing of water vapor portions of the air, so as to form a fine ice fog. This can cause severe frostbite upon exposure all over, still it is by inhalation to severe cold damage to the mucous membranes and tissue structures of the respiratory tract. This may lead to a laryngospasm. In addition to local damage effects is possible by inhaling the inert cryogenic gases suffocation.

The direct inhalation of hot gases can cause severe burns in the nose and throat. As the gases cool rapidly due to water absorption from the mucous membranes, the injuries are mainly in the supraglottic area. It can be found accompanying injuries like singed hair, burns to the face, soot or burns in the throat. It is depending on the extent of the injury to wheezing, coughing and shortness of breath. It may form a distinct edema of the upper respiratory tract with the risk of airway obstruction up to 48 hours after the trauma. Accompanying more burns on the body may be present depending on the circumstances of the accident.

Treatment is symptomatic and includes in addition to oxygen delivery analgesia. The previously recommended dose of inhaled corticosteroids such as beclomethasone is not recommended according to current knowledge.

The chemical inhalation trauma

In chemical inhalation trauma it comes to inhalation of chemical pyrolysis eg combustion of plastics or chemicals. In particular products of combustion of the sulfuric acid, nitric acid, hydrochloric acid, hydrogen cyanide, phosgene, ammonia, and hydrogen chloride compounds are responsible. Gases such as ammonia, hydrogen chloride or sulfuric acid have the advantage that they can be noticed even before reaching harmful concentrations by odor or onset of irritation, so that people can withdraw from affected areas. Inhalation of chemical irritant gases may form on the mucous membranes of a corrosive liquid film, which can lead to dependency on the local concentration to tissue injury such as irritation to burns. Due to the low concentration of pollutants films may lead to a long exposure time local that cause slowly progressive tissue damage and can result after a latency period of up to 24 hours of an acute decompensation with pulmonary edema due to mild symptoms. As a result, there may be a Acute Respiratory Distress Syndrome ( ARDS).

The damages are below the glottis and can be detected by laryngoscopy or bronchoscopy. Treatment is symptomatic and consists of oxygen administration and analgesia. Be distinguished from a more serious injury, early intubation and ventilation is indicated. During a bronchoscopy, a bronchoalveolar lavage is carried out to reduce the local concentration of pollutants.

The toxic inhalation trauma

A special form of chemical inhalation trauma is the toxic inhalation trauma. Here it comes to the inhalation of toxic gases and combustion products. While the chemical inhalation trauma is present, the local effect on airways and lungs, problems arise when toxic inhalation trauma to a systemic effect of inhaled gases and substances. In a fire, it often comes to a poisoning with carbon monoxide or hydrogen cyanide, which are included along with hydrochloric acid as Leitgase in fire smoke. Just a carbon monoxide poisoning often occurs in fire victims and calls for fires, most casualties.

The therapy includes not only symptomatic therapy with oxygen administration and termination of toxicant exposure differentiated antidotal therapy to interrupt or reduce the systemic effects of the pollutants already taken. For this purpose, information about the exact circumstances of the accident must be obtained in order to identify potential pollutants can.

As part of the rescue and first aid must be paid to the self-protection of the fire and rescue service personnel. With highly toxic substances can be assumed for the rescue team a threat of contaminated clothing or even the air exhaled by the patient.