Mild bleach burns to the respiratory tract are treated. Burn injuries of the upper respiratory tract: causes, diagnosis, emergency care

Inhalation injuries are observed in 15 - 18% of patients with burns admitted to the hospital, and they are the cause of 30 to 80% of all deaths from burns.

Inhalation burns result from direct action high temperature and/or toxic chemical damage. Dry air with a temperature of 500 C cools to almost 50″ C during the time it reaches the caria. As for chemicals, among them there are those that cause a toxic effect as a result of absorption, and those that damage the tracheobronchial lining upon direct contact with it. The most toxic are carbon monoxide and cyanide, which quickly lead to a fatal outcome. Toxic chemicals of direct contact action are varied. In burnt materials and rubber, polyvinyl chloride is found, which is a source of aldehyde, hydrochloric acid and chlorine. When nylon, rubber, silk, and petroleum products burn, ammonia is released. All these and various other substances cause direct damage to the mucosa respiratory tract.

The assessment of a patient with a respiratory tract burn should first include a thorough history. Clinically observed in the throat, hoarseness, dysphagia, cough, burning sputum, stridor, nasal congestion, tachypnea, restlessness, confusion or agitation. During examination, you can detect singed hair in the nose, burns on the face, and upon auscultation - wheezing and wheezing. Sometimes severe inhalation injuries are not only asymptomatic, but even with normal laboratory parameters.

In the first days after an inhalation burn, acute respiratory failure may develop, progressing to the lungs and pneumonia. Inhalation injury can be most accurately diagnosed using bronchoscopy (flexible bronchoscope) or xenon-133 scanning.

Treatment of inhalation burns begins at the scene of the accident. It is necessary first of all to provide a supply of 100% oxygen, which accelerates the elimination of carbon monoxide. Humidification of the inhaled gas, supply of oxygen and careful cleaning of the respiratory tract are the main components emergency therapy. Steroids should not be used in the treatment of inhalation injuries. used only in cases where there are clear, objectively confirmed signs of infection. Indications for intubation and ventilatory support are any of the following symptoms and factors: increasing stridor with clear signs of upper airway edema and obstruction; hypoxemia; inability to clear the airways from mucus; ineffectiveness of spontaneous breathing, despite dissection of the scab in circular burns chest; increased intracranial pressure as a result of cerebral hypoxia.

In this article:

Lung burns are classified as lesions internal organs, which, unlike superficial burn injuries, occur in a more severe form and can lead to quite serious, sometimes irreversible, consequences. Such a burn can occur when inhaling hot air, combustion products or chemical fumes. Inhalation damage to the lungs does not occur in isolation, but is always combined with other burns of the respiratory tract: the mucous membrane of the nose, larynx and trachea. Such injuries are diagnosed in 15-18% of burn patients admitted to the hospital.

An injured person who has suffered a burn to the lungs should be immediately taken to the hospital for first aid and medical care. surgical treatment. Often a burn respiratory system, combined with significant damage skin, leads to death. Despite the timely delivery medical care, many patients, whose body has not coped with the injuries caused, die in the first three days after receiving the injury. The resulting necrosis and pulmonary edema leads to cessation of respiratory function.

Difficult diagnosis of lung burns aggravates the situation. In some cases, inhalation lesions are completely asymptomatic, maintaining high laboratory parameters. Such damage can be suspected after collecting a complete medical history and clarifying all the circumstances of the injury. As an indirect diagnostic method Clinical examination data may be used. Damage to the lungs may be indicated by the localization of burns on the surface of the chest, neck and face, as well as traces of soot on the tongue and in the nasopharynx. The victim often begins to choke, there may be a change in voice, vomiting blood, coughing with sputum containing soot particles.

All these symptoms will not allow us to determine the extent and depth of the lesion. However, they are the ones who will help doctors make a preliminary diagnosis and provide the necessary medical care in a timely manner. Treatment of such burns begins at the scene with careful lavage of the airway and provision of oxygen. If edema, hypoxemia, obstruction occurs, as well as if it is impossible to clear the airways from mucus and increased intracranial pressure resulting from cerebral hypoxia, ventilation support and intubation are prescribed. Burn injury to the lungs increases the victim's fluid requirement by 50%. With inadequate infusion therapy, the severity of the burn injury may worsen, causing the development various complications. Antibiotic treatment is used only in those in rare cases when observed obvious signs infections.

Thermal lesions

Thermal inhalation lesions of the lungs, as a rule, occur during a fire that occurs in a confined space, for example, in a vehicle, small living or working space. Such injuries are often combined with severe skin burns, cause acute respiratory failure and can lead to the death of the victim. In the first few hours, the clinical picture is characterized by uncertainty.

Defeat can be assumed based on several signs and manifestations:

Impaired consciousness;
Dyspnea;
Hoarseness of voice;
Cough with black sputum;
Cyanosis;
Traces of soot on the mucous membrane of the pharynx and tongue;
Burnt back wall throats.

Victims are hospitalized in a specialized burn center or intensive care unit of the nearest multidisciplinary hospital. A thermal burn can lead to complications such as the development of respiratory failure or the occurrence of a syndrome acute lesion lungs. In this case, in addition to the main treatment, respiratory support may be required, such as artificial ventilation lungs, nebulizer therapy and innovative methodology extracorporeal membrane oxygenation.

Chemical lesions

The main substances whose vapors can cause a chemical burn to the respiratory tract include various acids, alkalis, volatile oils and salts heavy metals. Cyanides and carbon monoxide are the most toxic to human body. When oil products, rubber, nylon, silk and other materials are burned, ammonia and polyvinyl chloride are released, which are a source of chlorine, hydrochloric acid and aldehyde. All these toxic substances can cause burns to the respiratory tract and lungs.

The severity of the lesions can vary and depends on several factors:

Duration of exposure;
Degrees of concentration;
Temperatures;
The nature of chemicals.

The harmful effects of aggressive agents will be more pronounced when high concentration solutions. However, even weakly concentrated substances long-term exposure on humans can cause lung burns.

Unlike thermal damage, a chemical burn has a less pronounced clinical picture. TO characteristic features include severe pain immediately after injury, difficulty breathing, nausea, dizziness and loss of consciousness. Burn breaks normal functioning lungs and without timely treatment can lead to the development of the syndrome respiratory distress, acute burn toxemia and burn shock. The last of these conditions is life-threatening.

Chemical burns of the respiratory tract rarely lead to death in patients. However, if any characteristic symptoms, should be called ambulance. Doctors will remove it quickly painful sensations, restore breathing and blood circulation. All these actions will help prevent the development of burn shock.

In the first hours after injury, it is advisable to carry out inhalations. For these purposes, in case of an acid burn, a weak alkali solution is used, respectively, in case of an alkali burn, a weak acid solution is used. In addition to inhalation therapy, anti-inflammatory and hyposensitizing therapy are actively used. Because airway damage leads to injury vocal cords, all affected people are advised to remain silent for the first two weeks.

Thermal and chemical burns lungs can arise from inhalation of flame, smoke, hot air and vapors saturated with aggressive chemical elements. Such injuries are often life-threatening and often end in fatal. To identify all possible internal damage and surgical treatment, the victims are immediately taken to specialized medical institutions.

Lung burns occur as a result of exposure to hot smoke, chemical agents and other substances. The problem will manifest itself depending on the degree and volume of the lesions. This is also taken into account when selecting treatment methods.

Burn injury to the lungs is possible due to inhalation of chemicals:

Acid. Chlorine damage is most common.
Alkali. Caustic soda, ammonia, caustic soda
Alcohol.

Thermal burns occur if a person inhales hot smoke, steam, or high-temperature liquids.

Such injuries are accompanied by the development inflammatory process, damage to the mucous membrane, epithelium, circulatory disorders.

Classification of burns by degree

A respiratory burn develops in several stages. The first degree is characterized by a burn of the oral mucosa, epiglottis and larynx. This may occur as a result of ingestion of boiling liquid or exposure to burning fumes. If the lung is affected, the mucous membrane swells and pain occurs when swallowing. More severe cases are characterized by the appearance of blisters and white plaque. There is a swallowing disorder.

The second stage is manifested by burn damage to the respiratory system. Such lesions are more severe. They affect the epiglottis, its cartilages and folds, pharynx, and trachea.

Third degree burns pose a serious danger to human health and life. In this case, the development of hyperemia is observed. The bronchi lose their ability to retain moisture, and mucus accumulates in the respiratory tract. In this case, respiratory failure develops, severe swelling, burn shock.

Symptoms of damage will appear depending on the severity of the burn.

Clinical manifestations

People with respiratory tract burns experience the following symptoms:

burn injury to the face and neck;
the appearance of burnt hair in the nose;
formation of soot on the tongue and palate;
the appearance of necrotic spots on the oral mucosa;
swelling of the nasopharynx;
the voice becomes hoarse;
appear during swallowing painful sensations;
troubled by difficulty breathing and dry cough.

To receive detailed information A bronchoscopic examination is prescribed to determine the extent of the lesions.

During the first twelve hours after injury, the airways swell and development occurs. Gradually, the burn leads to the formation of foci of inflammation in the respiratory tract, which requires urgent treatment.

Thermal lung damage

A lung burn can occur during a fire in a vehicle or residential area. Such lesions usually occur under the influence of hot air and appear along with skin injuries and are accompanied by severe respiratory failure and death of the patient. During the first few hours, it is quite difficult to determine the clinical picture. Damage can be detected by several symptoms:

disturbance of consciousness;
dyspnea;
skin cyanosis;
traces of soot on the tongue and oral mucosa;
damage to the pharyngeal wall.

Thermal burns are dangerous as they can cause respiratory failure or acute lung damage. Treatment in these cases is carried out in special burn centers or in intensive care units hospitals.

Chemical damage to the respiratory system

Burns occur under the influence of chemicals. This may be the influence of alkalis, volatile oils, salts of heavy metals, and various acids. Cyanide and carbohydrate oxide are highly toxic. The combustion of petroleum products, rubber, silk and nylon items is accompanied by the release of ammonia and polyvinyl chloride. These are sources of chlorine, hydrochloric acid, and aldehyde.

These substances cause a chemical burn to the respiratory tract. How severe this damage is depends on the duration of exposure, the concentration and type of chemicals, and the temperature.

Aggressive agents, even at low concentrations, can cause lung burns.

Chemical damage is accompanied by bright clinical picture. The patient suffers from severe pain, nausea, dizziness, difficulty breathing, loss of consciousness. Treatment is carried out in a hospital.

As a result of the burn, lung function is impaired. This leads to a life-threatening condition - burn shock.

First aid for burns

In case of burns of the respiratory tract, it is important to provide timely assistance to the victim. To do this you need:

protect the patient from influence harmful substances and ensure the influx fresh air;
if the person has not lost consciousness, he needs to be given a semi-sitting position so that his head is raised;
in an unconscious state, the patient should be placed on his side so that in case of vomiting he does not choke on the vomit;
in case of burns with acids, treatment is carried out using rinsing with a solution of baking soda;
alkaline damage is eliminated with water and acetic or citric acid;
It is important to transport the patient to a medical facility as quickly as possible to continue treatment.

During transportation, it is necessary to monitor the state of breathing. If it is terminated, carry out artificial respiration. Only as a result of timely assistance, even with burns of the respiratory tract, can one count on a favorable prognosis.

Treatment methods

First of all, treatment for damage to the respiratory system is carried out as follows:

an intravenous anesthetic is administered;
wash your face with cool water;
rinse your mouth with chilled boiled water;
in case of acute pain, the oral cavity is treated with a solution of novocaine or lidocaine;
Put an oxygen mask on the patient and provide fresh air.

Depending on the type of injury, appropriate emergency care is provided. They also use general medicinal methods treatment. They allow:

Get rid of swelling of the larynx and ensure normal air access.
Eliminate painful sensations and eliminate shock.
Ensure the outflow of mucous secretion from the bronchi and lungs, which is produced as a result of a burn.
Prevent the development of an inflammatory process in the lungs.
Avoid collapse of a certain part of the lung.

To alleviate the patient’s condition, be sure to use anti-inflammatory, decongestant and painkillers. In addition, for full recovery damaged organs, the patient must remain silent for two weeks and take inhalations.

Treatment of lung burns is carried out using antibacterial drugs.

You can count on a good prognosis if timely treatment first degree burns. The greater the volume of affected tissue, the worse the situation. Often such burns lead to the death of the patient.

A burn to the respiratory organs or their individual zones is a life-threatening injury that occurs as a result of hot steam, chemically active elements or smoke entering the throat and lungs. Further recovery, prognosis and assessment of the patient’s condition depend on immune system and degree of injury.

Provoking factors may include steam, evaporation of chemicals, hot liquid or open fire.

A burn of the upper respiratory tract is accompanied by the following manifestations:

pain when trying to take a deep breath;
plaque in the oral cavity (tongue, inner side cheeks, sky);
white spots or redness in the throat area;
puffiness or swelling;
restriction when trying to draw air during inhalation and exhalation;
change in the vocal range (associated with a violation of the integrity of the ligaments);
cough without expectoration;
in rare cases, necrosis.

Typical division

All damage of this type is divided into:

chemical - as a result of direct contact with the reagent;
thermal - under the influence high temperatures solid objects, liquid or vapor.

Let's look at each type in more detail:

Chemical damage can be caused by acids, chlorine-containing elements, alkaline actives, and salt concentrate.
provoking factor thermal burns– hot liquid or steam from it, overheated food and the like (sometimes bronchial spasm develops, which significantly worsens the patient’s condition).

Localized classification

Burns of the respiratory tract, depending on the area of damage, or rather its location, are divided into:

Lungs and bronchus - most often of a thermal type, are accompanied by an accumulation of mucus, which significantly complicates the breathing process. As a result, pulmonary failure often develops. When inhaling smoke, not only thermal, but also chemical burns of the respiratory tract are characteristic, which are especially dangerous to human life and health.
Laryngeal - a typical injury that occurs after swallowing hot liquids or food. This type of injury is much more dangerous than similar burns to the oral cavity. Side effect are purulent formations.
Pharyngeal - a burn of the respiratory tract almost completely similar to the previous type in clinical manifestations. In addition to this, blistering formations and plaque may appear.
Tracheal – accompanied acute pain, sometimes shortness of breath and problems with natural ventilation as a result of involuntary contraction of the epithelial vocal tract.

First aid

All activities to provide first aid must appear in a strictly defined sequence.

Let's look at the order step by step:

limit the victim’s contact with the irritant;
provide free access to oxygen;
the person must take a horizontal position (head raised);
oral cavity should be rinsed a large number water (you can dissolve analgin or chloramphenicol in it);
if contact with acid occurs, add a few grams of soda to the water, and in case of alkaline damage, add a little acetic acid;
then call an ambulance;
when transporting yourself, monitor the patient’s respiratory activity (check the mouth for secretions, perform artificial respiration if necessary).

Treatment

For any type of burn, specialists strive to achieve the following goals:

reduce and completely eliminate swelling;
normalize the breathing process;
relieve pain and spasms;
prevent pulmonary failure and pneumonia.

To perform health improvement, medications of different pharmacological groups are prescribed:

painkillers - Panadol, Promedol, Ibuprofen, Prosidol;
antibacterial - Ibuprofen, Nurofen, Ketorolac;
to eliminate edema - Lasix, Diacrab;
as a supplement - Diphenhydramine, Diazolin.

To speed up the rehabilitation process, special hardware inhalations (with cold steam) are prescribed.

Conclusion

Self-treatment does not always lead to positive results. Not all information in global network are truthful and fully describe the treatment process. It is best to visit a qualified specialist and do not ignore pain symptoms. Otherwise, inflammation and even necrosis may develop.

You can prevent unpleasant situations by carefully checking the liquid before use. Try not to consume hot food and keep active reagents away from children. Basic safety rules, if followed, will save the lives of you and your loved ones.

Smoke inhaled by humans may contain nitric or nitrous acid, and in the case of inhalation of burnt plastic, hydrocyanic acid gas and phosgene. Such smoke is very poisonous and causes chemical and pulmonary edema, so it is very important to be able to promptly and correctly provide first aid to the victim.

Clinic for chemical burns of the upper respiratory tract

In a fire in an enclosed space, the victim most often suffers lung damage. Chemical burns of the upper respiratory tract and disruption of the lungs - all this leads to hypoxia (insufficient supply of oxygen to the body tissues). In adults, it manifests itself in the form of anxiety, pale skin, in children - in the form of severe fear, tearfulness, and sometimes the occurrence of spastic muscle contractions and cramps. This condition is often the cause of death in indoor fires.

Also, with chemicals, the nasopharynx and oropharynx may develop stenosis (narrowing) of the larynx. On early stages The development of his clinic is as follows:

Hoarseness of voice or its complete disappearance (aphonia) appears;
shortness of breath occurs;
the back wall of the pharynx and palate are burned;
cyanosis appears (the color of the mucous membranes and skin becomes bluish);
breathing becomes intermittent due to convulsive contraction of the neck muscles;
consciousness is impaired.

Help with burns of the respiratory system

First of all, the victim needs to be provided with a flow of fresh air, after which chemical burns of the respiratory system are treated.

Treatment begins with copious rinsing of the skin of the face and oropharynx. cold water. After this, acid burns are treated with a 1-2% solution baking soda, and alkaline burns are neutralized with weak (1-2%) solutions of vinegar or citric acid. Next, to reduce pain, the oral cavity is treated with a 1% solution of novocaine or another anesthetic. They are also given 100% humidified oxygen to breathe through an inhaler mask and admitted to the burn intensive care unit.

For laryngeal stenosis, inhalation should be carried out with a solution of sodium bicarbonate with ephedrine and diphenhydramine. If these measures do not help, it is necessary to urgently call a surgeon for an emergency tracheostomy (dissection of the anterior wall of the trachea) and hospitalize the victim in the hospital.

Local treatment of burns of the upper respiratory tract in a hospital is the same for both chemical and thermal burns. The main thing is to provide the victim with the necessary medical care in a timely manner.