Inhalation trauma
| Classification according to ICD-10 | |
|---|---|
| T27.0 | Burns of the larynx and trachea |
| T27.1 | Burns of the larynx and trachea involving the lungs |
| T27.2 | Burns to other parts of the airways |
| T27.3 | Burns of the respiratory tract, part unspecified |
| T27.4 | Burns of the larynx and trachea |
| T27.5 | Burns of the larynx and trachea involving the lungs |
| T27.6 | Corrosion to other parts of the airways |
| T27.7 | Corrosion of the respiratory tract, part unspecified |
| X46 | Accidental poisoning by and exposure to organic solvent (s) and halogenated hydrocarbons and their vapors (s) |
| X47 | Accidental poisoning by and exposure to other gas (s) and vapors (s) |
| X48 | Accidental poisoning by and exposure to pesticide (s) [pesticide (s)] |
| X49 | Accidental poisoning by and exposure to other and unspecified chemicals and noxious substances |
| ICD-10 online (WHO version 2019) | |
The inhalation trauma refers to a chest trauma due to inhalation of corrosive , toxic , hot or cryogenic gases or aerosols . This can damage the upper and lower airways as well as the lungs . Depending on the cause of the trauma, one differentiates between three forms:
- The thermal inhalation trauma
- The chemical inhalation trauma
- The toxic inhalation trauma
The thermal inhalation trauma
In the case of thermal inhalation trauma, hot gases are inhaled, e.g. B. in fires or explosions or cold gases when inhaling aerosols released cryogenic liquids and substances such. B. liquid nitrogen .
When cryogenic gases are released, aerosol clouds of the liquid gas form in the ambient air . These cause the water vapor in the air to freeze, so that a fine ice mist forms. If exposed, these can cause severe frostbite damage to the whole body, and inhalation can also cause severe cold damage to the mucous membranes and tissue structures of the respiratory tract. This can lead to a glottic cramp . In addition to the local consequences of damage, inhalation of the cryogenic inert gases can cause suffocation.
Direct inhalation of hot gases can cause severe burns in the nose and throat. Since the gases cool down rapidly through absorption of water from the mucous membranes, the injuries are mainly found in the supraglottic area. There are accompanying injuries such as scorched hair, burns on the face, soot or burns in the throat. Depending on the extent of the injury, stridor , coughing and shortness of breath occur. Pronounced edema of the upper airways with the risk of airway obstruction can develop up to 48 hours after the trauma . Additional burns may also be present on the body, depending on the course of the accident.
The therapy is symptom-oriented and includes analgesia in addition to the administration of oxygen . The previously recommended administration of inhaled corticosteroids such as beclometasone is no longer recommended based on current knowledge.
The chemical inhalation trauma
Chemical inhalation trauma involves inhalation of chemical pyrolysis products, e.g. B. when burning plastics or chemicals. In particular, combustion products of sulfuric acid , nitric acid , hydrochloric acid , hydrocyanic acid , phosgene , ammonia and hydrogen chloride compounds are the cause. Gases such as ammonia, hydrogen chloride or sulfuric acid have the advantage that they can be noticed by smell or the onset of irritation before they reach harmful concentrations, so that people can withdraw from the affected areas. If chemical irritant gases are inhaled, a caustic film of liquid can form on the mucous membranes, which, depending on the local concentration, can lead to tissue damage such as irritation or even chemical burns. Low-concentration pollutant films can result in long local exposure times due to minor discomfort, which cause slowly progressive tissue damage and, after a latency period of up to 24 hours, can lead to acute decompensation with pulmonary edema. This can lead to Acute Respiratory Distress Syndrome (ARDS).
The damage lies below the glottic level and can be detected using laryngoscopy or bronchoscopy. The therapy is symptom-oriented and consists of oxygen administration and analgesia . If more severe damage is evident, early intubation and ventilation are indicated. As part of a bronchoscopy , bronchial lavage can be performed to reduce the local concentration of pollutants.
The toxic inhalation trauma
A special form of chemical inhalation trauma is toxic inhalation trauma. This is where toxic gases and combustion products are inhaled. While chemical inhalation trauma has local effects on the airways and lungs, toxic inhalation trauma has a systemic effect of inhaled gases and substances. In the event of a fire, there is often poisoning with carbon monoxide or hydrogen cyanide , which, together with hydrochloric acid , are contained in the smoke as lead gases . Carbon monoxide poisoning in particular occurs frequently in fire victims and claims the most fatalities in fires.
In addition to symptomatic therapy with oxygen and ending the exposure to toxins, the therapy includes a differentiated antidote therapy to interrupt or reduce the systemic effects of the pollutants already absorbed. For this purpose, information about the exact course of the accident must be obtained in order to identify possible pollutants.
In the context of rescue and first aid, attention must be paid to the self-protection of fire and rescue service personnel. In the case of highly toxic substances, the rescue team can pose a risk of contaminated clothing or even the patient's exhaled air.
Individual evidence
- ↑ a b c d e f g h i j k l m Ralf Gahr (ed.): Handbuch der Thorax-Traumatologie, Volumes I and II. Einhorn-Presse Verlag, 2007, ISBN 978-3-88756-812-2 .
- ↑ Recommendations for the preclinical care of burn patients ( Memento of the original from October 29, 2012 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. of the German Society for Burn Medicine e. V. (accessed on November 23, 2012)
- ^ Association for the Promotion of German Fire Protection: Guideline 10/01 Evaluation of Pollutant Concentrations in Fire Fighting Operations (accessed on November 26, 2012)
