Gas exchange can be compromised for a number of reasons:
Direct damage from inhalation injury to lower airways and gas exchange surfaces
Carbon monoxide (CO) can quickly build up impairing oxygen carrying capacity 9,10.
Burnt tissues with significant loss of the elasticity in superficial fibres are known as an eschar. This creates a constricting effect and inhibits expansion (figure 11). When circumferential around the chest/torso/neck this can lead to impaired chest expansion and subsequent ventilation issues9,10,11
Figure 11
Assessment:
Exposure of the chest to assess for any injuries, and adequacy of ventilation
Prompt assessment of oxygenation with a saturation probe9,10,11
Baseline blood gas (to assess oxygenation, ventilation, and carbon monoxide9,10,11
Management
Initially high flow oxygen (bear in mind that peripheral saturation readings may be falsely elevated with raised carbon monoxide levels), which can be later titrated to target appropriate saturations9,10
Immediate discussion with burns centre if any restriction of movement of chest9,10
Suspected inhalation injury may warrant intubation9,10
Common pitfalls:
Failure to recognise rising CO level
Failure to recognise poor ventilation and the need for escharotomy
Top Tips:
Escharotomy can be a lifesaving procedure that relieves restriction of movement and allows chest expansion. This is an emergency situation this will be discussed later
Cyanide poisoning is common in patients that have been exposed to inhalation of burnt household items. In profound hypoxia consider early administration of cyanokit .10
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