1/22. Pneumomediastinum associated with inhalation of white smoke.Hexachloroethane (HC) smoke, also known as white smoke, is an obscurant used in numerous military situations. Many adverse health effects are associated with the use of white smoke, some of which are potentially life threatening. Inhalation is the most frequent route of injury. Two deaths among U.S. Army personnel resulted from HC smoke exposure in 1988. As recently as 1997, a united nations soldier in Bosnia died after an HC smoke canister was discharged in his tent. Injuries are predominantly pulmonary and range from cough and dyspnea to chemical pneumonitis, pulmonary edema, and adult respiratory distress syndrome. In the case presented, a soldier developed pneumomediastinum after exposure to HC smoke. This is the first case reported in the literature of pneumomediastinum associated with HC smoke inhalation.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
2/22. Extracorporeal support in an adult with severe carbon monoxide poisoning and shock following smoke inhalation: a case report.The objective of this study was to discuss the case of a patient with severe smoke inhalation-related respiratory failure treated with extracorporeal support. The study was set in a 12-bed multi-trauma intensive care unit at a level one trauma center and hyperbaric medicine center. The patient under investigation had carbon monoxide poisoning, and developed acute respiratory distress syndrome and cardiovascular collapse following smoke inhalation. Rapid initiation of extracorporeal support, extreme inverse-ratio ventilation and intermittent prone positioning therapy were carried out. Admission and serial carboxyhemoglobin levels, blood gases, and computerized tomography of the chest were obtained. The patient developed severe hypoxia and progressed to cardiovascular collapse resistant to resuscitation and vasoactive infusions. Veno-venous extracorporeal support was initiated. Cardiovascular parameters of blood pressure, cardiac output, and oxygen delivery were maximized; oxygenation and ventilation were supported via the extracorporeal circuit. Airway pressure release ventilation and intermittent prone positioning therapy were instituted. Following 7 days of extracorporeal support, the patient was decannulated and subsequently discharged to a transitional care facility,neurologically intact. Smoke inhalation and carbon monoxide poisoning may lead to life-threatening hypoxemia associated with resultant cardiovascular instability. When oxygenation and ventilation cannot be achieved via maximal ventilatory management, extracorporeal support may prevent death if initiated rapidly.- - - - - - - - - - ranking = 0.00053468716779977keywords = chest (Clic here for more details about this article) |
3/22. Acute pulmonary oedema following smoke inhalation.A case of acute pulmonary oedema after smoke inhalation from a chip pan fire is presented. The role of bronchial and pulmonary circulation in the development of pulmonary oedema after smoke inhalation is discussed. We stress the importance not only of observation after smoke inhalation, as the manifestation of pulmonary oedema may be delayed, but also of a baseline chest X-ray before admission for comparison.- - - - - - - - - - ranking = 0.00053468716779977keywords = chest (Clic here for more details about this article) |
4/22. Failure to clear casts and secretions following inhalation injury can be dangerous: report of a case.A 27-year-old man suffered smoke inhalation during a fire. Three days later, he complained of respiratory difficulty and was admitted to our hospital. bronchoscopy revealed a very large buildup of sputum mixed with soot extending from the left main bronchus to the bifurcation of the upper and lower lobe bronchi and causing both pulmonary atelectasis and pneumonia. The debris was successfully removed the next day with basket forceps via bronchoscopy. The patient's airway pressure dropped significantly, enabling extubation almost immediately. Because of the possibility for respiratory failure caused by viscous secretion, it is important to perform initial bronchoscopy in cases of suspected inhalation injury.- - - - - - - - - - ranking = 5keywords = injury (Clic here for more details about this article) |
5/22. Early and late fatal complications of inhalation injury.Severe inhalation injury causes a substantial deterioration in the prognosis and increases the general mortality of patients with extensive burns. Recently, in particular due to the development of invasive monitoring of patients and effective treatment of acute burn shock, we encounter with increasing frequency patients who survive the acute stage, including complications such as ARDS, and reach the stage of late complications. The latter include tracheooesophageal fistulas that develop on the basis of pressure ulcers and chondromalacia, usually at the site of the balloon of the tracheostomic cannula, and the overproduction of fibrous tissue in the area of the airways which leads to the development of stenosis, pulmonary fibrosis and bronchiectasia. Frequently, different early and late complications combine.- - - - - - - - - - ranking = 5keywords = injury (Clic here for more details about this article) |
6/22. Plastic reconstruction of an extended corrosive injury of the posterior tracheal wall with an autologous esophageal patch.We report on a patient with an extended corrosive injury of the posterior tracheal wall and left-sided tracheo-esophageal fistula after severe inhalative trauma. Resection of the fistula and necrotic tissue was followed by reconstruction of the posterior tracheal wall with an esophageal patch. Interposition of the stomach was performed to restore upper gastro-intestinal continuity. Revision was necessary due to an anastomotic insufficiency and a recurrent fistula between the trachea and the esophago-gastrostomy on the left side. The stomach was resected and the fistula was covered with a sternocleidomastoideus muscle flap. Several weeks later interposition of the right hemicolon was performed to establish the gastro-intestinal tract and the patient recovered completely, thereafter.- - - - - - - - - - ranking = 5keywords = injury (Clic here for more details about this article) |
7/22. Pulmonary vascular lesions in the adult respiratory distress syndrome caused by inhalation of zinc chloride smoke: a morphometric study.Two soldiers were fatally injured by accidental inhalation of zinc chloride (ZnCl2) from a smoke bomb. Although exposed to a relatively short but high smoke concentration, acute injury was minor and for 10 days the patients were clinically satisfactory. Unexpectedly, both then rapidly developed features typical of severe adult respiratory distress syndrome with pulmonary hypertension. intubation and mechanical ventilation were instigated on day 15 (patient no. 1) and day 12 (patient no. 2) after the inhalation, but death followed at days 25 and 32, respectively. Lung vascular injury was assessed by angiography and morphometric techniques. The lungs showed extensive interstitial and intra-alveolar space fibrosis. Vessels showed a significant lumen reduction by contracture (that is, reduction in vessel external diameter) affecting preacinar and intraacinar arterial and venous segments, the extent of injury suggesting that hexite causes more severe venous injury than seen in other types of adult respiratory distress syndrome. In microvessels there was obliteration and widespread occlusion by endothelial cell proliferation and clot. No evidence of infection was identified during life or at autopsy. It is unclear whether the long lag time was due to the fact that the infection was not a complicating event or because steroids, administered prophylactically, had sufficed to delay, but not to prevent, the amplification of injury that seems responsible for the adult respiratory distress syndrome.- - - - - - - - - - ranking = 5keywords = injury (Clic here for more details about this article) |
8/22. Successful management of adult smoke inhalation with extracorporeal membrane oxygenation.Pulmonary complications remain one of the leading causes of mortality in patients with burns. We report two cases of adult patients with thermal and inhalation injuries who were placed on extracorporeal membrane oxygenation (ECMO) and survived. Patient 1 was a 42-year-old male who suffered 15% TBSA and a severe inhalation injury requiring intubation upon arrival to the emergency department. Patient 2 was a 24-year-old female in a house fire who received 20%TBSA and was noted to be in respiratory distress and intubated on the scene by the paramedic team. Three days after admission, patient 1 developed severe respiratory failure. He decompensated, despite maximum conventional management, and was placed on ECMO. After 300 hours of ECMO, his pulmonary function had improved, and he was decannulated. Patient 2 also developed severe refractory respiratory failure and was placed on ECMO. She was decannulated 288 hours later. Both patients were discharged home shortly afterwards and have managed well. ECMO should be considered when patients are facing a respiratory death from inhalation injury on conventional mechanical ventilation.- - - - - - - - - - ranking = 2keywords = injury (Clic here for more details about this article) |
9/22. Computed tomography--a possible aid in the diagnosis of smoke inhalation injury?Inhalation injury is an important contributor to morbidity and mortality in burn victims and can trigger acute lung injury and acute respiratory distress syndrome (ARDS) (1-3). early diagnosis and treatment of inhalation injury are important, but a major problem in planning treatment and evaluating the prognosis has been the lack of consensus about diagnostic criteria (4). Chest radiographs on admission are often non-specific (5, 6), but indicators include indoor fires, facial burns, bronchoscopic findings of soot in the airways, and detection of carbon monoxide or cyanide in the blood (7). Changes in the lungs may be detected by bronchoscopy with biopsy, xenon imaging, or measurement of pulmonary extracellular fluid (4, 5, 8). These methods have, however, been associated with low sensitivity and specificity, as exemplified by the 50% predictive value in the study of Masanes et al. (8). Computed tomographs (CTs) are better than normal chest radiographs in the detection of other pulmonary lesions such as pulmonary contusion (9, 10). The importance of CT scans in patients with ARDS has been reviewed recently (9), but unfortunately there has been no experience of CT in patients with smoke inhalation injury. To our knowledge, there are only two animal studies reporting that smoke inhalation injury can be detected by CT (4, 11); specific changes in human CT scans have not yet been described. Therefore, confronted with a patient with severe respiratory failure after a burn who from the history and physical examination showed the classic risk factors for inhalation injury, we decided to request a CT.- - - - - - - - - - ranking = 10.000534687168keywords = injury, chest (Clic here for more details about this article) |
10/22. Successful healing of a burn injury covering 100% of TBSA and 96% IIIrd degree with inhalation injury.The authors describe successful healing of a burn injury covering 100% of TBSA with 96% full-thickness skin loss and inhalation injury. The patient was admitted to the burn department of our hospital on September the 4th 1987. He smoothly overcame the shock stage with help of fluid replacement and application of alkaline drugs in large quantities. Early escharectomy and repeated micrografting were performed. The treatment is discussed.- - - - - - - - - - ranking = 10keywords = injury (Clic here for more details about this article) |
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