Cases reported "Burns, Inhalation"

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1/66. Symptomatic tracheal stenosis in burns.

    tracheal stenosis in burns is rare and usually results from prolonged intubation or tracheostomy. inhalation injury itself has the potential risk of tracheal stenosis. We reviewed the records of 1878 burn patients during 1987 to 1995 and found seven with tracheal stenosis (0.37%) after an average of 4.4 years follow up. There were 4 males and 3 females with an average age of 27.3 years. The tracheal stenosis developed 1-22 months after burn (average 7 months). Five patients had their inhalation injury confirmed by bronchoscopic examination. The incidence of tracheal stenosis among inhalation injury patients was 5.49% (5/92). Six patients needed intubation in the initial stage either for respiratory distress or prophylaxis, with an average duration of 195.2 h. In addition to prolonged intubation, the presence of inhalation injury, repeated intubations and severe neck scar contractures are also contributors to tracheal stenosis in burns. We favor T-tube insertion as the first treatment choice; permanent tracheostomy was unsatisfactory in our study. ( info)

2/66. Electrocautery-ignited endotracheal tube fire: case report.

    The risk of fire in the airway associated with laser surgery is well known, but there are reports of endotracheal tube fires ignited by electrocautery, particularly during pharyngeal surgery or tracheostomy or both. This uncommon complication has potentially devastating consequences. Surgeons undertaking these procedures should be aware of this complication and be familiar with measures to avoid them. We present a case report of an electrocautery-ignited endotracheal tube fire during an elective tracheostomy, which resulted in the patient's death. ( info)

3/66. Complete fusion of the vocal cords; an unusual case.

    A case is presented of a woman who sustained a 35% body surface area mixed depth cutaneous burn, together with a significant inhalational injury. The patient required emergency resuscitation with endotracheal intubation and subsequently tracheostomy. This resulted in an unfortunate complication of a total adhesion between the vocal cords which extended into the subglottic area, causing complete occlusion of the airway. ( info)

4/66. Surfactant treatment in a pediatric burn patient with respiratory failure.

    This report describes surfactant treatment in a burned infant with severe respiratory failure. In this patient the instillation of surfactant rapidly improved compliance, oxygen index (OI), and alveolar-capillary oxygen gradient (AaDO2), while the need for oxygen supplementation and peak positive pressure drastically decreased. The treatment was repeated after 12 hours. Although the baby had severe clinical course complications as a Gram-negative sepsis and a subglottic stenosis, she was weaned from oxygen therapy and mechanical ventilation in few weeks. Surfactant dysfunctions seem to play a central role in the respiratory insufficiency of burned patients, and its exogenous replacements could improve their outcome. ( info)

5/66. Anhydrous ammonia burns case report and review of the literature.

    Chemical burns are associated with significant morbidity, especially anhydrous ammonia burns. Anhydrous ammonia is a colorless, pungent gas that is stored and transported under pressure in liquid form. A 28 year-old patient suffered 45% total body surface area of second and third degree burns as well as inhalational injury from an anhydrous ammonia explosion. Along with fluid resuscitation, the patient's body was scrubbed every 6 h with sterile water for the first 48 h to decrease the skin pH from 10 to 6-8. He subsequently underwent a total of seven wound debridements; initially with allograft and then autograft. On post burn day 45, he was discharged. The injuries associated with anhydrous ammonia burns are specific to the effects of ammonium hydroxide. Severity of symptoms and tissue damage produced is directly related to the concentration of hydroxyl ions. Liquefactive necrosis results in superficial to full-thickness tissue loss. The affinity of anhydrous ammonia and its byproducts for mucous membranes can result in hemoptysis, pharyngitis, pulmonary edema, and bronchiectasis. Ocular sequelae include iritis, glaucoma, cataracts, and retinal atrophy. The desirability of treating anhydrous ammonia burns immediately cannot be overemphasized. clothing must be removed quickly, and irrigation with water initiated at the scene and continued for the first 24 h. Resuscitative measures should be started as well as early debridement of nonviable skin. patients with significant facial or pharyngeal burns should be intubated, and the eyes irrigated until a conjunctivae sac pH below 8.5 is achieved. Although health care professionals need to be prepared to treat chemical burns, educating the public, especially those workers in the agricultural and industrial setting, should be the first line of prevention. ( info)

6/66. hydrogen sulfide inhalation injury.

    hydrogen sulfide is a colorless, noxious gas with the distinctive smell of rotten eggs. This compound is a powerful reducing agent that is encountered in a number of industrial processes. When hydrogen sulfide is present, it exposes workers to the potentially lethal effects of the rapid hypoxemia that results from exposure to this agent. The "warning sign" is the characteristic smell of rotten eggs; this smell should alert anyone in the area that a potentially serious risk exists. The immediate removal of the victim and administration of high-flow oxygen is essential. Neurologic sequelae may require anticonvulsants and care must be exercised to observe for cardiac, hepatic, and renal insufficiency. Depending on the concentration, hydrogen sulfide can rapidly overcome a potential victim. ( info)

7/66. Airway fire due to diathermy during tracheostomy in an intensive care patient.

    We describe a case of airway fire in an 83-year-old, critically ill patient. The fire occurred during a surgical tracheostomy under general anaesthesia, following ignition of the tracheal tube by diathermy. After debridement of the burnt tissue and treatment with intravenous antibiotics and glucocorticoids, the patient's respiratory function worsened initially. The patient eventually recovered without long-term sequelae and was discharged from the intensive care unit. The circumstances of this and other similar incidents are reviewed, as are the suggested methods for preventing this frightening occurrence. ( info)

8/66. Acute management of exposure to liquid ammonia.

    ammonia injury is an uncommon injury, but it is associated with high morbidity and mortality. This case report demonstrates the pathophysiology and treatment of both cutaneous burn wounds and inhalation injury caused by ammonia. Frequent bronchoscopy was used to attempt to avoid intubation and its associated morbidity. The patient remained extubated, but later he required skin grafts to close his wounds after healing of his pulmonary injury. A review of the management of inhalation injury is also discussed. ammonia injury can cause a severe inhalation injury. bronchoscopy can be a useful tool to avoid intubation. ( info)

9/66. Successful reconstruction of extensive laryngotracheal strictures after inhalation burn injury: report of a case.

    We report a rare case of long segmental laryngotracheal stenosis following inhalation burn injury. The patient presented 2 months after his injury with progressive stridor and dyspnea necessitating tracheostomy. A computed tomographic scan of the neck revealed stenosis extending from the vocal cords to the top of the sternum. Repair was successfully carried out with multiple surgical procedures employing hinge-flap closure tented with autogenous tissue. ( info)

10/66. Radionuclidic lung-imaging procedures in the assessment of injury due to ammonia inhalation.

    Clinical, physiologic, and bronchoscopic findings in a young man with acute injury of the respiratory tract due to inhalation of ammonia are described. Six months later, the patient's pulmonary function was reassessed by three radionuclidic lung-imaging procedures, which first revealed the sites and extent of the persisting obstructive disease processes. The diagnostic accuracy of the initial findings with radioactive xenon and aerosol were verified by the results of repeated bronchoscopic examination, bronchographic studies, standard pulmonary function tests, and lung-imaging procedures. ( info)
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