A 42-yrs-old refinery worker is transferred to your burn

Discussion in 'MRCS Forum' started by Lona., Dec 10, 2007.

  1. Lona.

    Lona. Guest

    A 42-yrs-old refinery worker is transferred to your burn unit. He was dyspneic and in respiratory distress at the scene and was intubated by alert paramedics. Soot is suctioned from the tube. Characteristics of his condition include -
    a- Smoke poisoning is a thermal rather than a chemical injury
    b- Carbon monoxide levels are not likely to be elevated unless there is evidence of skin or oropharyngeal burns
    c- Chest x-rays during the early post-inhalation period show a characteristic ground-glass appearance
    d- Damage to the upper respiratory tract is common and is usually found on laryngoscopy
    e- Patients with elevated carboxyhemoglobin levels should be hospitalized for a minimum of 24 h
  2. Lona.

    Lona. Guest

    Answer: e. (Pruitt, J Trauma 30:S63-S68, 1990) Smoke inhalation injuries (smoke poisoning) and asphyxia account for almost one-third of all fire fatalities. As opposed to respiratory burns, which are thermal injuries of the upper respiratory tract, smoke inhalation is a chemical to the distal tracheobronchial tree and alveoli. Most patients admitted for this injury have elevated carbon monoxide levels, but a minority have physical evidence of skin burns (20%) or oropharyngeal burns (25%). Visible damage to the respiratory tract is not a frequent finding. Chest films initially are often negative even in those patients who subsequently develop respiratory failure from pulmonary edema or pneumonitis. Patients with elevated carboxyhemoglobin levels or evidence of smoke inhalation should be hospitalized for a minimum of 24 h for observation regardless of normal arterial blood gases and chest x-ray.

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