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n
Prevention
PULMONARY PROBLEMS
II.
RESUSCITATION PHASE (0 - 48 hours)
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.6-8 The second process is
the decreased chest wall compliance caused by
a deep chest wall burn.9
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.1-5
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.1-10 A closed space fire
can result in a severe hypoxic insult as well as
lung damage from the inhalation of the 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.
The causes in Table 1 are presented in the
typical order on which they appear with
resuscitation.
Figure 1:
Legend: Smoke exposure in a closed space fire
Introduction
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