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Thermal tracheal burns
Thermal burns of the trachea and other respiratory tract occur when inhaling the flame, hot air, smoke, steam. Purely thermal factors can be accompanied by chemical - toxic combustion products in smoke.
A burn of the respiratory tract should be suspected in all cases when the damage was received indoors (fire in the house, basement, transport, mine, in the fighting vehicle) and when there are signs of a face burn.
Thermal damage to the respiratory tract below the level of the larynx is less common, which is explained by a protective reflex - laryngospasm. Burns with flame cause predominant damage to the upper respiratory tract, especially the larynx. The defeat of the lower respiratory tract - the trachea and bronchi is more often observed when smoke enters them and is considered as a result of exposure to the mucous membrane of its components (V. Tsurikov, 1976).
Thermal damage to the respiratory tract can result in burn shock and severe respiratory failure, quickly leading to death. Violation of the drainage function of the damaged mucous membrane of the respiratory tract, a decrease in the cough reflex and restriction of respiratory excursions, contributes to the accumulation of mucus, and then fibrinous exudate and elements of desquamated epithelium, which can completely obstruct the lumen of the bronchi. In addition to the respiratory tract, lung tissue is also involved.
The clinical picture with thermal burns of the respiratory tract is almost always alarming. Occurs: aphonia, paroxysmally increasing shortness of breath, cyanosis, severe pain, salivation, cough, swallowing disorder.
Emergency care is needed during a period of burn shock, accompanied by severe respiratory failure. Bilateral cervical vagosympathetic blockade should be performed immediately. Effective means of combating bronchospasm are the introduction of intravenous prednisone (30 mg 1-2 times a day), atropine (0.5 - 1.0 ml), adrenaline (0.2 - 0.3 ml) and other bronchodilators (Schuster M .A.
et al., 1989). Cardiac agents are periodically administered. Osmotic diuretics (mannitol, mannitol, urea) are used to restore kidney function. With the development of pulmonary edema, inhalation of oxygen passed through alcohol is indicated. 10 mg of a 2.4% solution of aminophylline, 0.5 mg of a 0.05% solution of strophanthin (or 0.5-1 mg of a 0.06% solution of corglucon), 10 ml of a 10% solution of calcium chloride, 100-200 mg of hydrocortisone are administered intravenously or 30-60 mg of prednisolone, 80 mg of Lasix (Burmistov V.M. et al., 1981).
However, in the absence of obvious signs of burn shock, it is necessary to begin intensive treatment - oxygen inhalation, administration of antispasmodics, inhalation of 0.5% novocaine solution and 4% sodium bicarbonate solution. In emergency order, the elimination of pain and the elimination of psycho-emotional arousal are shown. For this purpose, mask anesthesia with nitrous oxide and oxygen in a ratio of 2: 1 can be given for 15-30 minutes. 2 ml of a 2% solution of promedol and 2 ml of a 1% solution of diphenhydramine are administered intravenously.
Inhalation therapy is important, for example, inhalations of the following composition are recommended: 10 ml of a 0.25% solution of novocaine, 1 ml of a 2.4% solution of aminophylline, 0.5% solution of ephedrine, 1 ml of a 1% solution of diphenhydramine, to which 0 is added. 5 g of sodium bicarbonate (Schuster, M.A. et al., 1989).
In order to prevent infectious complications, antibiotics are administered in the usual dosage. With increasing acute stenosis of the larynx, a tracheostomy is performed, after which you need to strive for the earliest possible decanulation.
In recent years, a flexible fibroscope with a channel for suctioning fluids has been used to free the airways of desquamated epithelium and exudate. With its help, they get an idea of the condition of the tracheobronchial tracts and produce lavage - a 0.9% sodium chloride solution is poured and aspirated.
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Thermal tracheal burns
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