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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.
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.
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
- Thermal and chemical burns of the respiratory tract
ICD-10 code T27 Diagnostics Diagnosis Mandatory Level of consciousness, effectiveness and respiratory rate, blood pressure, heart rate, medical history, physical examination R-graph of chest organs Bronchoscopy Laboratory tests: bacterial culture 2-3 days after a burn, hemoglobin, gases blood, carboxyhemoglobin, methemoglobin, electrolytes (Na, K, Cl), coagulation
- CHEMICAL BURNS
Chemical burns can be caused by organic and non-organic substances in the solid, liquid and gaseous state. The degree of damage depends on the amount of substance, its concentration and time of contact with the skin. The pathogenesis of chemical burns differs from the pathogenesis of thermal lesions. When concentrated acids act on the skin, tissue proteins coagulate (with the formation of
- The mechanisms of respiratory failure in the pathology of the respiratory tract
The development of DN in diseases of the respiratory tract is due to an increase in resistive resistance to air flow (RL). In this case, the ventilation of the affected areas of the lung is disturbed, the resistive work of breathing increases, and fatigue and weakness of the respiratory muscles can be the result of irreparable obstruction of the DP. Due to the fact that airway resistance (according to Poiseuille's law)
- Chemical burns of the esophagus
Esophageal burns are usually of a chemical nature, with the exception of the rarest cases of thermal burns. Chemical burns of the esophagus occur with the accidental or deliberate (with suicidal purpose) intake of aggressive fluids inside. Currently, the most common cause of such burns is acetic essence (80% solution of acetic acid). The pathogenesis of a chemical burn of the esophagus is quite typical.
- THERMAL AND CHEMICAL BURNS
Animals with thermal or chemical burns are killed for meat when they are in an incurable condition or their treatment and maintenance are not economically feasible in the future. Thermal burns in animals are the result of exposure to tissue of high temperature (fire, hot water, hot air), radiation energy, and electric current. As a result of thermal burns in animals,
- Chemical burns
Scope of the examination 1. Chemical burns cause corrosive liquids - concentrated acids and caustic alkalis. 2. Acids have a cauterizing and necrotic effect, coagulation of tissue proteins; alkalis dissolve proteins and cause kallikvatsionny necrosis. 3. Signs of a chemical burn if liquid gets inside are: burns on the face, lip mucosa, oropharynx, hoarseness
- Thermal and chemical burns
ICD-10 code T20 - T32 Diagnosis Diagnosis Mandatory Consciousness level, effectiveness and respiratory rate, blood pressure, heart rate, medical history, physical examination, burn surface area Consultation of a combiologist (traumatologist, surgeon) Laboratory tests: hemoglobin, blood gases, carboxyhemoglobin electrolytes (Na, K, Cl), coagulation indicators (APTT, PTV,
- Thermo-inhalation respiratory tract lesions
Thermo-inhalation injury occurs as a result of direct damage to the respiratory tract by flame, hot air, steam and toxic combustion products. DIAGNOSTICS Typically, thermo-inhalation lesions occur during a fire in an enclosed space (in a vehicle, in a residential or working room) and are often combined with skin burns. Burns of the upper respiratory tract and
- ACUTE RESPIRATORY OBSTRUCTION
Airway obstruction - impaired patency develops as a result of inflammatory processes (acute laryngotracheobronchitis), swelling and spasm of the glottis, aspiration, trauma. In some cases, this is extremely dangerous, since total airway obstruction and a quick fatal outcome are possible. Obstruction of the upper and lower respiratory tract is characterized by different
- Airway management
Masterly mastery of all the skills required to ensure airway patency is an integral part of the skill of an anesthesiologist. This chapter presents the anatomy of the upper respiratory tract, describes equipment and techniques for ensuring airway patency, and discusses the complications of laryngoscopy, intubation, and ex-tubation. Patient safety is direct
- Airway obstruction
Airflow can be limited at any level of the tracheobronchial tree. Even in the absence of the main pathology of the lungs, a discrete obstacle, if it is located at the level of the larynx, trachea or main bronchus, disrupts the passage of air flow (obstruction of the upper respiratory tract). Compression of the mediastinum due to fibrosis, granuloma, or tumor can narrow the trachea or main bronchus.
- RESPIRATORY TORNES
Definition Rupture of the airways is called traumatic perforation or rupture of any part of the airways. Etiology Ruptures of the walls of the respiratory tract under the influence of thermal or mechanical energy. Neck hyperextension combined with direct exposure to an unprotected trachea. Penetrating chest wounds. Erosion of the tracheobronchial wall with an ETT cuff.
- RESPIRATORY INTUBATION
INDICATIONS The main indications for endotracheal intubation are: a) the need for respiratory support or the delivery of high concentrations of respirable oxygen; b) protection of the respiratory tract from aspiration; c) removal of secretions accumulating in the airways; d) decrease in resistance in the upper respiratory tract. NEED FOR VENTILATION SUPPORT AND POSITIVE PRESSURE AT THE END
- RESPIRATORY BURN
Definition A burn of the respiratory tract is a thermal or chemical lesion of the mucous membrane of the respiratory tract from the mouth to the alveoli. Etiology Ignition of ETT during laser surgery. Inhalation of hot gases: the inhaled gases are too hot; there is a direct effect of fire; exposure to smoke or toxic gases.
- LOWER RESPIRATORY OBSTRUCTION
Aspiration of liquids (water, blood, gastric juice, etc.) and solid foreign bodies, anaphylactic reactions, and exacerbation of chronic pulmonary diseases accompanied by bronchial obstruction syndrome lead to acute obstruction of the lower respiratory tract (NDP) - trachea and bronchi - (Table 5.2). Vomiting aspiration often occurs in a state of coma, anesthesia, severe intoxication
- Effect of anesthesia on airway resistance
It might be expected that a decrease in FOB caused by anesthesia leads to an increase in airway resistance. However, this, as a rule, does not happen, because inhalation anesthetics, widely used to maintain anesthesia, have bronchodilating properties. Increased airway resistance is often due to retraction of the tongue, laryngospasm, bronchoconstriction,
- UPPER RESPIRATORY DISEASES
Lewis Weinstein (Louis Weinstein) Diseases of the upper respiratory tract (nose, nasopharynx, sinuses, larynx) are among the most common human diseases. In the vast majority of cases, this pathology, accompanied by transient malaise, does not carry a direct threat to life and does not cause prolonged disability. Diseases of the nose
- Airway Restoration
Basic resuscitation measures First of all, in a person found in an unconscious state, one should quickly assess the airway, breathing and blood circulation. If CPR is needed, they immediately call for help from assistants and a resuscitation team. The resuscitator is laid on his back on a hard surface. Airway obstruction is most often due to displacement.
- Upper airway obstruction
Acute obstruction of the upper respiratory tract due to pathological processes leading to narrowing of the larynx and bronchi is the most common cause of acute respiratory failure, requiring emergency treatment at the prehospital stage in children. The urgency of the situation is associated with early developing decompensation, which, in turn, is due to the narrow respiratory tract of the child, the presence of loose