Respiratory burn. Thermal burns of the respiratory tract and esophagus

Upper burn respiratory tract very dangerous: its consequences can be severe disability and even death. The frequency of such injuries at work and at home is about 1% of all cases.

What causes a burn

The mucous membranes of the respiratory organs are damaged when they are exposed to:

thermal - hot steam, other hot gaseous substances, boiling water, flame;
chemical - vapors of acids, alkalis, poisonous gases (chlorine, ammonia, carbon monoxide).

There is a risk of getting a similar burn in a Russian bath or sauna due to prolonged inhalation of hot vapors.

Smoke, hot air and chemical vapors entering respiratory system, cause severe chemical burns aggravated by thermal effects. Such combined injuries can lead to the death of the victim.

Symptoms

In addition to the upper respiratory tract, tissue damage to the face, head, neck and chest often occurs. Symptoms depend on the degree, surface area and depth of damage, and the nature of the damaging agent.

traces of burns on the face, around the lips (hyperemia, serous blisters);
breathing is difficult;
severe pain in the oropharynx, especially when trying to take a deep breath;
foci of necrosis on the mucous membranes;
swelling of the nasopharynx;
profuse salivation, pain when swallowing;
laryngeal stenosis, suffocation;
increase in temperature;
nasal and hoarse voice.

1st degree - slight hyperemia of the mucous membrane of the oropharynx and epiglottis. There are isolated dry rales in the lungs. If the vocal folds are not damaged, the voice is not changed.
2nd and 3rd degree burns (severe and extremely severe) of the respiratory tract are combined with extensive damage to the body. This condition develops after being in a closed room during a fire. Burn of the face, nose, lips. Bright hyperemia with streaks of soot on the tongue, on back wall throats. On the tongue and soft palate there are areas of necrotic tissue. Acute emphysema, suffocation. In the lungs throughout all fields there is harsh breathing, abundant dry wheezing.

With spasm of the glottis, asphyxia with respiratory arrest is possible. On days 2-3, the condition worsens, wheezing in the lungs becomes moist, and in places there is crepitus. Consciousness is absent or altered. Severe ones develop mental disorders: hallucinations, delusions.

At deep lesions As a result of multiple thromboembolism of the pulmonary vessels, the blood supply to the lungs is disrupted. Swelling of the mucous membranes increases, acute respiratory failure, atelectasis (collapse of areas of the lung), pneumonia, cardiac and renal failure. Mortality in the first three days exceeds 50%.

Diagnostics

Diagnosis of the lesion is carried out to clarify the depth and level of organ damage. The examination is carried out using a laryngoscope or bronchoscope. Bronchoscopy - more informative method, allowing you to examine the trachea and bronchi and visually assess the degree of damage to the mucous membrane of the respiratory tract.

in the first case - catarrhal inflammation;
with the second - erosive;
in severe cases, deep ulcerative-necrotic defects are formed.

Pathological changes in blood and urine will appear 2-3 days after injury. IN general analysis signs of inflammation are visible in the blood: leukocytosis, accelerated ESR, anemia. In the urine - hematuria, renal casts.

Combustiologists treat patients with severe burn lesions of the skin and mucous membranes, including the respiratory tract.

What to do first

Approximate procedure:

Chemical burn

Aggressive action of fumes of chemical reagents (acid, alkali, gas, salt heavy metals) on the mucous membrane of the respiratory tract leads to necrosis of soft tissues.

The list of chemicals that can cause extensive damage includes alcohol, which contains poisonous alcohols. A characteristic feature injury is severe pain, difficulty breathing, dizziness, loss of consciousness. To reduce the destructive effect, the victim’s nose and mouth are washed with water for 20 minutes.

If the exact cause of the burn is known:

Thermal damage

Thermal burns occur when inhaling hot steam, air or getting boiling liquid into the oropharynx. The skin around the nose and mouth is damaged. The victim develops shock, bronchospasm, and if the lungs are burned, breathing and circulation are impaired.

Treatment

Medical care is provided to patients in intensive care units hospitals. Principles of therapy for severe inhalation injury:

If there is a threat of asphyxia and other respiratory complications - intubation, tracheostomy or transfer of the victim to artificial ventilation.

Drugs and procedures used:

Possible complications and consequences

The outcome for 1st degree burns is usually favorable.

Consequences severe lesions respiratory tract:

emphysema;
damage to the vocal cords;
severe recurrent pneumonia;
failure of internal organs;
irreversible necrotic processes of the trachea and bronchi, which often result in death.

In case of burns of the trachea during the healing period, a rough tissue develops in place of the dead epithelium lining the surface. connective tissue. Deformation of the breathing tube occurs with impaired breathing function. In the late post-traumatic period after stabilization of the patient’s general condition, reconstructive plastic surgery to restore normal breathing.

People who have suffered severe burns of the respiratory tract are prone to frequent bronchopulmonary diseases. For the purpose of prevention, they are recommended to undergo treatment at sea resorts and stay in salt mines.

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:

painful sensations when trying to take a deep breath;
raid in oral cavity(language, 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;
V 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.
the provoking factor of thermal burns is hot liquid or steam from it, overheated food, etc. (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 burn respiratory tract, 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 by acute pain, sometimes shortness of breath and problems with natural ventilation as a result of involuntary contraction of the epithelial vocal passage.

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);
the mouth 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, if necessary, perform artificial respiration).

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.

When a chemical agent acts on the mucous membrane, skin and tissues, damage begins to occur, which leads to chemical burns. The main substances that cause damage include acids, alkalis, heavy metal salts and volatile oils.

The severity of injuries from a chemical burn depends on how concentrated the substance was and how long it affected the person. The effect will be more pronounced if the solutions are concentrated, but even weakly concentrated substances with prolonged exposure can lead to chemical lung burn.

Clinical picture and severity of chemical burns of the lungs.

The depth of damage to any burn can vary and is not very easy to determine. A characteristic symptom is severe pain that appears immediately after the injury. All burns are divided into four degrees of severity.

Clinical picture of a chemical burn, including chemical burns of the lungs, not as pronounced as with thermal damage. Post-burn disease is characterized by phenomena that are observed only with chemical damage.

Manifestation in a chemical burn:

Acute burn toxemia, burn shock, septicotoxemia, convalescence.

With chemical burns of the lungs, deaths are not so common. It depends on the nature of the action of the substance. For example, under the influence of concentrated acids, rapid and severe tissue dehydration and protein breakdown begin to occur. Sulfuric acid affects the appearance of a white scab, which turns blue and then black. Alkalis penetrate much deeper, but they act more slowly than acids. Caustic alkalis dissolve proteins and saponify fats.

Consequences and symptoms of chemical burns to the lungs.

External chemical burns can lead to skin changes: increased humidity, discoloration, redness and inflammation of the affected area. In this case, the tissues swell and the person feels pain.

Inhalation of smoke and certain substances leads to chemical burns to the lungs and respiratory tract. People who suffer a chemical burn to the lungs often lose consciousness and have difficulty breathing. At the same time normal operation lungs is impaired, and if the affected person does not receive timely treatment, the syndrome may begin to develop respiratory distress, which is life-threatening to the victim.

Symptoms of a lung burn from chemicals.

Nausea, dizziness, laryngeal swelling, pain in chest, difficulty breathing are the main symptoms of a chemical burn of the lungs.

If such symptoms appear, you need to call ambulance. First of all, doctors restore blood circulation and breathing to the injured person, and also relieve pain.

It is worth considering that the stronger the chemical burns to the lungs, the greater the risk of developing shock. But chemical burns do not cause as much damage as other injuries.

Thermal burns occur when hot liquids are swallowed or hot gases are inhaled. A burn to the respiratory tract should be suspected in all cases where the damage was received in a closed or semi-closed room (fire in a house, basement, transport, mines), if it was caused by steam, flame, explosion, when the victim’s clothes were burning.

At the moment of exposure to hot liquid or gas or immediately after it, the victim may develop burn shock, and the immediate reaction to a burn of the respiratory tract is laryngo- or bronchospasm. Already during the period of burn shock, severe respiratory failure may develop due to mechanical obstruction of the airways, bronchospasm and changes in the lung tissue. Impaired drainage function of the respiratory tract, decreased cough reflex and limited respiratory excursions contribute to the accumulation of mucus and then fibrinous exudate, which can completely close the lumen of the bronchi. In addition to the respiratory tract, lung tissue is involved in the process.

With the mildest burns (I degree), the patient has no signs of respiratory failure, with second degree burns they occur 6-12 hours after injury, and with third degree burns - at the moment of exposure to hot liquid or gas. For first-degree burns, only hyperemia and swelling of the mucous membrane within the upper respiratory tract are characteristic; for second-degree burns, infiltration is also noted, and in places exposed to the most severe impact - gray-white plaques. Bubbles on the mucous membrane rarely form [Tarasov D. I et al., 1982]. With third degree burns, the mucous membrane becomes necrotic.

In the trachea and bronchi with thermal burns of the first degree, there is mild hyperemia and swelling of the mucous membrane, the spur of the tracheal bifurcation remains sharp and mobile. In case of second degree burns, there is pronounced hyperemia and swelling with a significant overlap of fibrinous films, which sometimes form “casts”, edema and a bifurcation spur. In severe third degree burns, there is a lot of thick sputum and fibrinous films in the lumen of the trachea and bronchi. Ulcerations often accompany edema, but are not always easy to detect

The clinical picture of severe thermal burns of the respiratory tract is almost always alarming: aphonia, paroxysmal increasing shortness of breath, cyanosis, severe pain, salivation, cough, difficulty swallowing. In case of flame burns, burning of the hair in the vestibule of the nose, traces of soot on the mucous membranes, and sputum mixed with soot are detected.

May be violated general condition or increase body temperature. In the larynx pathological changes most pronounced in the area of its vestibule. Swelling of the mucous membrane of the larynx is the cause of stenosis, but it does not develop immediately, but over several hours.

Tracheostomy for burns of the upper respiratory tract is indicated only in cases of respiratory decompensation caused by degree III-IV stenosis and no effect from conservative therapy, mechanical asphyxia and severe respiratory failure with extinction of the cough reflex. It is also performed for burns of the lower respiratory tract when the face and neck are exposed to flame, when constant toileting is necessary, comatose states burnt people, the development of pneumonia and atelectasis.

Burns on the anterior surface of the neck, including third degree, are not a contraindication to this operation. Tracheostomy can also be performed under local anesthesia, and under anesthesia.

If using aspiration through a tracheostomy it is not possible to free the lower respiratory tract from mucus, detritus and crusts, then sanitizing lower tracheobronchoscopy, sometimes endofibroscopy, is indicated.

The clinical manifestations of a burn of the respiratory tract also depend on the time that has passed since the injury. Thus, swelling of the larynx reaches its maximum after 6-12 hours. According to S.K. Boenko et al. (1983), on the 1st day after the burn, victims complain of dry nose, soreness and discomfort in the throat, pain when swallowing. At this time, there is usually a bright “dry” hyperemia of the mucous membrane of the nose, pharynx and larynx.

On the 2-3rd day, hoarseness and difficulty breathing may appear. Burns of the wings of the nose and lips, white spots of burn necrosis on the nasal mucosa, soft palate, at the entrance to the larynx and in the area of the vocal folds - the most common signs severe burn, detected during examination starting 2-3 days after injury.

Emergency care is necessary during burn shock with severe respiratory failure. A bilateral cervical vagosympathetic blockade should be performed immediately. By effective means Intravenous prednisolone (30 mg 1-2 times a day), atropine (0.5-1 ml), adrenaline (0.2-0.3 ml) and other bronchodilators are also used to combat bronchospasm. They can also be administered by inhalation, slightly warmed beforehand.

For infusion therapy use a 0.1% solution of novocaine, polyglucin, plasma, albumin, as well as balanced solutions such as lactosol. The amount of liquid transfused per day should not exceed 3-3.5 liters; it must be administered slowly. In addition, cardiac drugs are periodically administered - strophanthin, cocarboxylase, ATP, etc. To restore kidney function, osmotic diuretics are used: mannitol, mannitol, urea. When decreasing blood pressure Prednisolone, hydrocortisone and 40-60 mg are prescribed ascorbic acid per day.

With the development of pulmonary edema, inhalation of oxygen passed through alcohol is indicated. 10 mg of 2.4% solution of aminophylline, 0.5 mg of 0.05% solution of strophanthin (or 0.5-1 mg of 0.06% solution of korglykon), 10 ml of 10% solution of calcium chloride, 100-200 mg of hydrocortisone are administered intravenously or 30-60 mg of prednisolone, 80 mg of Lasix [Burmistrov V. M. et al., 1981].

However, in the absence of signs of burn shock, it is necessary to immediately begin intensive treatment - inhalation of oxygen, administration of antispasmodics, inhalation of a 0.5% solution of novocaine and 4% solution of sodium bicarbonate. As an emergency, pain relief and elimination of psycho-emotional arousal are indicated. For this purpose, it can be given for 15-30 minutes. mask anesthesia nitrous oxide with oxygen in a ratio of 2:1. 2 mg of a 2% solution of promedol and 2 ml of a 1% solution of diphenhydramine are administered intravenously.

It is important inhalation therapy, for example, they recommend inhalations of the following composition: 10 ml of 0.25% novocaine solution +1 ml of 2.4% aminophylline solution + 0.5 ml of 5% ephedrine solution +1 ml of 1% diphenhydramine solution, to which 0.5 g of bicarbonate is added sodium

Then they prescribe cold on the neck, swallowing pieces of ice and oils ( fish oil), intravenous administration 10-20% glucose solution, plasma, hemodez, Ringer's solution or isotonic sodium chloride solution. Currently, the use of corticosteroid drugs in large doses- up to 15-20 mg of hydrocortisone per 1 kg of body weight. Antibiotics are prescribed at the same time.

Locally, for applications to the burned mucous membrane of the oral cavity and pharynx, you can use cigerol, carotoline, retinol, and spraying proposol. Enteral nutrition is allowed from the 2-3rd day, for the first time after rinsing with a 5% novocaine solution or taking anesthesin. Food in the first days should be liquid and not hot.

Thermal burns of the esophagus can occur as a result of swallowing hot liquid, so they are accompanied by a similar burn of the mouth and pharynx. In the mouth and pharynx, the burn is always more pronounced than in the esophagus. In this regard, the treatment of these burns does not differ from that for damage to the pharynx and larynx. Topically applied medicinal substances are recommended to be swallowed whenever possible.

IN. Kalina, F.I. Chumakov

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 possible due to inhalation 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 lesion lungs. Treatment in these cases is carried out in special burn centers or in intensive care units of a hospital.

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, 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 provide a flow of 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 stops, artificial respiration is performed. 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;
at 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 damage, appropriate emergency assistance. 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.