Breathing
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
- 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 issues.9-10
Assessment:
- Exposure of the chest to assess for any injuries, and adequacy of ventilation
- Prompt assessment of oxygenation with a saturation probe9,10
- Baseline blood gas (to assess oxygenation, ventilation, and carbon monoxide9,10
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
- Immediate discussion with burns centre if any restriction of movement of chest9
- Suspected inhalation injury may warrant intubation8,9
Common pitfalls
- Failure to recognise rising CO level.
- Failure to recognise poor ventilation and the need for escharotomy.
Learning bites
- Escharotomy can be a lifesaving procedure that relieves restriction of movement and allows chest expansion. This is an emergency situation.
- Cyanide poisoning is common in patients that have been exposed to inhalation of burnt household items. In profound hypoxia consider early administration of cyanokit®.9