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Chemical burns of the respiratory and esophageal tract

Chemical burns of the respiratory tract

Chemical burns occur as a result of ingestion or inhalation of concentrated chemical solutions (acids, alkalis, etc.). Most often, the vestibular part of the larynx is affected (epiglottis, scoop-epiglottis and vestibular folds, arytenoid cartilage). At the site of contact of the chemical agent with the mucous membrane, a local burn reaction occurs in the form of hyperemia, edema, the formation of fibrous plaque. In severe cases, damage to the skeleton of the larynx is possible.

Clinic.

Functional disturbances come to the fore: difficulty breathing and a change in voice up to aphonia. Laryngoscopy data indicate the location and size of the lesion of the larynx, changes in the glottis, the nature of edema and infiltrate, fibrous plaque and its prevalence. In each case, it is necessary to exclude the possibility of diphtheria.

Treatment.

In the first 1-2 hours after the burn, inhalation with a weak (0.5%) solution of alkali (with acid burn) or acid (with alkali burn) is advisable. The same substances need to rinse the throat and oral cavity. An indispensable condition is compliance with silence for 10-14 days. To relieve pain, rinse with warm decoctions of chamomile, sage 2 times a day for 2-3 weeks. In the presence of odor from the mouth and fibrinous films on the mucous membrane of the oral cavity and pharynx, rinse with a weak solution of potassium permanganate. A good effect is given by inhalation therapy. Inhalations of menthol, peach, apricot oils, antibiotics are used in combination with a suspension of hydrocortisone (15-20 procedures per course). Active anti-inflammatory and hyposensitizing therapy is carried out.

Chemical burns of the digestive tract.

Chemical burns of the pharynx and esophagus occur when swallowing corrosive liquid poisons, most often concentrated solutions of acids and alkalis, taken accidentally or with a suicidal purpose. When exposed to acid, a dense scab forms, when exposed to alkalis, a soft, loose scab is formed. Three degrees of pathological changes in tissues are clinically distinguished:

I degree - erythema;

II degree - blistering;

III degree - necrosis. Clinic.

In the first hours and days after a burn, acute pain in the throat and along the esophagus is characteristic, intensifying with swallowing and coughing. Extensive scabs form on the mucous membrane of the lips and oral cavity, pharynx. If toxic substances enter the larynx, trachea, coughing and suffocation attacks occur. In some cases, a toxic substance can be recognized by smell.

With burns of the first degree, only the superficial epithelial layer is damaged, which is rejected for 3-4 days, exposing the hyperemic mucous membrane. The general condition of the patient suffers little. II degree burns cause intoxication, which is most pronounced on days 6-7 during the period of rejection of necrotic deposits, leaving erosion.
Since the thickness of the mucous membrane is damaged, the healing is granular with an outcome in the superficial scar. With the III degree of burn, the mucous membrane and underlying tissue are damaged at different depths, severe intoxication occurs. Scab rejection occurs by the end of the 2nd week, deep ulcers are formed, the healing of which lasts for several weeks, and sometimes months. In this case, gross deforming scars are formed, usually causing a narrowing of the esophagus.

Esophageal burns are often accompanied by complications such as laryngitis, tracheobronchitis, esophageal perforation, periesophagitis, mediastinitis, pneumonia, sepsis, and exhaustion. In childhood, burns of I and U degrees cause swelling of the pharynx and larynx, an abundance of sputum, which leads to significant respiratory failure due to stenosis in the throat and larynx.

Treatment for burns of the pharynx and esophagus should begin as early as possible, best at the scene. With chemical burns in the first 6 hours, it is necessary to neutralize the toxic substance. In the absence of an antidote, water should be used with the addition of half the volume of milk or raw egg proteins. Permissible gastric lavage with boiled warm water. If it is impossible to introduce a gastric tube, give 5-6 cups of washing liquid to drink, then induce vomiting by pressing on the root of the tongue. Rinsing should be repeated using 3-4 l of washing liquid.

Along with the neutralization and leaching of the toxic substance during burns of the II and III degrees, anti-shock and detoxification measures are indicated: a pantopone or morphine solution is injected subcutaneously with an intravenous-5% glucose solution, plasma, and fresh citrate blood. Cardiovascular and antibacterial drugs are used. If the patient can swallow, prescribe a sparing diet, drink plenty of water, give vegetable oil to be swallowed: if swallowing is not possible, vegetable and parenteral nutrition is indicated.

In many cases, with burns of the pharynx, the entrance of the larynx is involved in the process; the swelling that occurs here can dramatically narrow the lumen of the larynx and cause asphyxiation. Therefore, the presence of laryngeal edema is an indication for the use of pipolphene, prednisone, calcium chloride (drug destenization). In some cases, a tracheostomy is necessary. It is advisable to administer antibiotics during the entire period of ulcer healing (1-2 months), which is the prevention of pneumonia and tracheobronchitis, prevents the development of infection on the wound surface and reduces subsequent scarring.

The most common method for reducing cicatricial stenosis of the esophagus during the recovery process is early bougie or leaving the nasophageal probe in the esophagus for a long time.
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Chemical burns of the respiratory and esophageal tract

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