Clinical Challenges in Burn Surgery: Inhalation Injury

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 30 December 2024

⏱️ 47 minutes

🔗️ Recording | iTunes | RSS

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Summary

A nearby house fire has brought several patients to your hospital via ambulance, where you are the sole provider on duty. These patients require urgent triage and stabilization before transfer to the regional burn center. You are very concerned about inhalation injury and are tasked with making complex clinical decisions in a high-pressure situation. What are the next steps? Join Drs. Kevin Foster, Tina Palmeri, Ryan Rihani, Tommy Tran, and Kiran Dyamenahalli as they explore the intricacies of managing smoke inhalation injury and more!

Hosts:
Tommy Tran, Tristar Skyline Medical Center
Kiran Dyamenahalli, MGH Sumner Redstone Burn Center
Kevin Foster, Arizona Burn Center
Tina Palmeri, UC Davis Firefighters Burn Institute Regional Burn Center
Ryan Rihani, UT Health Dunn Burn Center
Tam Pham, Harborview Medical Center (Editor)

Learning Objectives:

Understand the etiology and common scenarios associated with inhalation injury
Understand the effect of inhalation injury on morbidity and mortality
Describe indications for invasive airway management (intubation, bronchoscopy, and mechanical ventilation).
Describe complications of inhalation injury and their management.

References:
Fournier, M., Turgeon, A. F., Doucette, S., Morrisette, M., Archambault, P., & Bouchard, N. (2016). Nebulized heparin for inhalation injury in burn patients: A systematic review and meta-analysis. Critical Care, 20(1), 1-10. https://doi.org/10.1186/s13054-016-1285-8
Norris, C., LaLonde, C., Slater, H., & Purser, D. (2005). Survival from inhalation injury. Burns, 31(7), 803-815. https://doi.org/10.1016/j.burns.2005.04.003
Li, W., Tang, X., Chen, Y., & Zhao, Z. (2021). Update on smoke inhalation injury: Pathogenesis, diagnosis, and treatment. Journal of Thoracic Disease, 13(4), 1797-1808. https://doi.org/10.21037/jtd-20-3328
Hahn, S. M., Kim, Y. H., Kim, K. H., & Lee, S. U. (2020). Advances in the diagnosis and treatment of smoke inhalation injury in burn patients. Acute and Critical Care, 35(1), 1-10. https://doi.org/10.4266/acc.2020.00175
Bittner, E. A., Shank, E., Woodson, L., & Martyn, J. A. (2015). Acute and long-term outcomes of burn injuries: A focus on inhalation injury. Clinics in Chest Medicine, 36(4), 549-560. https://doi.org/10.1016/j.ccm.2015.08.007
Romanowski, K. S., & Palmieri, T. L. (2019). Inhalation injury in burns: Pathophysiology, diagnosis, and treatment. Journal of Burn Care & Research, 40(5), 517-523. https://doi.org/10.1093/jbcr/irz123
Dyamenahalli, K., Garg, G., Shupp, J. W., Kuprys, P. V., Choudhry, M. A., & Kovacs, E. J. (2019). Inhalation injury: Unmet clinical needs and future research. Journal of Burn Care & Research, 40(5), 570-584. https://doi.org/10.1093/jbcr/irz055

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Transcript

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0:00.0	Behind the Knife, the Sur's burn section, we have the
0:26.9	burn inhalation injury podcast with your moderator's Tommy Tran. I'm a burn and surgical
0:32.0	critical care fellow at the Arizona Burn Center. This is Karen Diomenehally. I'm a critical care
0:37.3	and burn fellow at Mass General Hospital.
0:39.4	I'm excited to be here.
0:40.7	Your guests today are Kevin Foster from Arizona Burn Center, Tina Palmieri from
0:46.3	E.C. Davis and Ryan Vianney from the Winston Burn Center.
0:52.2	Dr. Viani, what is burn inhalation injury?
0:55.7	First of all, thank you guys for having me. I'm honored to be here with such other esteemed
1:00.3	guests. In our institution, we define burn inhalation injury as damage to the respiratory
1:07.3	track that results from the inhalation of hot gases, smoke, chemical fumes,
1:13.4	that occur during a fire or some other incident involving intense heat.
1:18.0	These injuries often occur in addition to the external burns that we're also aware of,
1:23.2	and they affect both the upper and the lower airways in different mechanisms.
1:27.9	So when a fire burns, we often see the smoke that results from it.
1:34.4	And the smoke is a complex mixture of gases and particles that are harmful to the respiratory system.
1:40.1	They contain carbon monoxide, cyanide, hydrogen, articulate matters, and various irritants
1:46.3	that can damage and significantly alter the respiratory tract.
1:50.8	And it starts in the nose, works its way all the way down to the bronchi and the alveoli.
1:55.4	Okay, why is it so important?
1:57.7	You know, if you look at the National Bird Repository, smoke inhalation injury is present at about 10 and 20% of all burn emissions. And why is it important?
2:05.7	Well, it significantly increases morbidity and mortality in these patients.
	...

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