Respiratory burn

A burn of the respiratory tract is damage to the mucous tissues of the respiratory organs, which develops at the moment of inhalation of a damaging agent: steam, chemical fumes, hot smoke, etc. The clinical course and condition of the victim depend on the area and depth of the damage, as well as on the quality and timeliness of the emergency care provided.

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Epidemiology

The greatest number of cases of respiratory tract burns was observed during wars: during these periods, the frequency of thermal injuries increased significantly, from 0.3% to 1.5% of the total number of victims. This is due to the mass use of explosives, flammable mixtures and thermal weapons.

In modern times, the frequency of burns, unfortunately, increases. For example, in Israel alone, as a result of military conflicts, burn injuries amounted to 5% to 9%. When using tanks and motorized transport, the percentage can increase to 20-40%.

In domestic conditions, the number of respiratory tract burns is significantly lower and accounts for less than 1% of all burn cases.

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Causes respiratory burn

A burn of the respiratory organs can be caused by:

• chemical fumes;
• high temperature.

The most severe burns are considered to be mixed burns, caused by a combination of chemical and thermal effects.

Chemical burns can be obtained at work, in case of accidental damage to containers with evaporating liquid. Rapid inhalation of such fumes often leads to internal tissue damage. In addition, inhalation of acrid smoke during a fire is possible. If such smoke contains phosgene, hydrocyanic or nitrous acid, or other toxic substances, then a respiratory burn is inevitable.

Thermal damage to the respiratory organs occurs when inhaling hot steam or air, or even flames.

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Pathogenesis

The pathogenesis of respiratory tract burns consists of thermal or chemical destruction of mucous and submucous tissues with disruption of their function. The degree of damage may vary, depending on the temperature and duration of exposure, on the depth of inhalation when the damaging agent enters. If the burn is significant, deep tissue necrosis may occur, which can cover several layers.

Often, burn injury is accompanied by an inflammatory process, with impaired vascular permeability and edema, which further complicates the respiratory function.

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Symptoms respiratory burn

The first signs of a burn of the respiratory organs appear immediately after exposure to a damaging factor. Such circumstances as a fire in an apartment, utility room, mine, transport, as well as short-term exposure to steam or open fire (especially if there is a burn of the chest, neck or facial area) may indicate the presence of a burn.

A burn of the upper respiratory tract is accompanied by sharp pain in the throat and chest. The pain intensifies when trying to inhale, so breathing is difficult. The body temperature may rise.

Visually, damage to the skin in the lip area can be detected, and the mucous membranes of the oral cavity are edematous and hyperemic. In severe cases, damage to the external laryngeal ring can lead to laryngeal stenosis and suffocation.

Stages of a burn	Symptoms			Complications
	Cyanosis	Wheezing in the lungs	Coughing, spitting up, voice unrecognizable	Respiratory and cardiac failure	Pneumonia
Stage I (burn of the oral mucosa, epiglottis, larynx). Stage II (burn damage of the respiratory organs of the second and third degree).	It happens rarely. Sharply expressed.	Vague, dry wheezing. A large number of dry wheezing sounds, which after 2-3 days become wet and turn into crepitations.	Not typical. Frequent dry cough, sputum is released from the 2nd-3rd day. The voice is hoarse, aphonia is possible.	No. Often occurs on the 2nd-3rd day.	Occasionally, it has a favorable course. Develops in almost all cases. The course is severe.

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Forms

Depending on what factor caused the damage to the respiratory system, different types of such injuries are distinguished. All of them differ, first of all, in clinical symptoms.

• Chemical burns of the respiratory tract can be suspected in the presence of chemical damage to the skin of the neck, face, chest, and mouth. The victim often has breathing problems, his voice changes, bloody vomiting, and a cough with dirty discharge appear.
• A chlorine burn of the respiratory tract is accompanied by a sharp burning sensation in the throat, nasal cavity and behind the breastbone. At the same time, lacrimation, severe frequent cough and toxic rhinitis may be observed. The mucous membrane of the respiratory tract remains irritated for several days after the action of the damaging factor has ceased.
• An acid burn of the respiratory tract can be determined by the condition of the back wall of the pharynx. In most cases, the mucous membrane there initially turns white or yellow, then becomes dirty green and then almost black. A crust forms on the surface, which bleeds when rejected.
• A burn of the respiratory tract by paint vapors causes swelling of the nasopharynx, sneezing, and coughing. The victim complains of shortness of breath and difficulty breathing. The skin is pale, the eyes turn red. Headache and dizziness often occur.
• Thermal burn of the respiratory tract is accompanied by shortness of breath, blue skin, and changes in voice. During examination, obvious burn damage to the pharynx and upper palate can be seen. The patient shows anxiety, fear, which is often associated with severe pain and difficulty breathing. In severe cases, loss of consciousness occurs.
• A burn of the respiratory tract during a fire is the most typical. This type of injury is characterized by damage to the lips, neck, and oral cavity. Upon examination, a burnt inner surface of the nostrils is observed. When examining the secretion from the bronchi and nasal cavity, traces of soot can be found.
• A burn of the respiratory tract by steam is usually accompanied by laryngospasm, without significant damage to the trachea, bronchi and lungs. The fact is that when inhaling hot steam, a protective reaction is triggered in the form of an involuntary contraction of the larynx muscles. Therefore, this type of burn can be considered the most favorable.

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Complications and consequences

Minor burns of the respiratory tract of the first degree usually do not cause negative consequences and are cured without any particular problems.

In case of stage II or III burn injury, complications with rather negative prognoses may develop.

Among the most unfavorable complications, the following can be distinguished:

• development of emphysema - a chronic lung disease that is accompanied by the expansion of small bronchioles and damage to the integrity of the interalveolar septa;
• changes in the structure of the vocal cords;
• chronic pneumonia;
• failure of pulmonary and cardiac function;
• renal failure;
• phenomena of necrosis and fibrosis in the trachea and bronchi, which can ultimately lead to death.

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Diagnostics respiratory burn

Usually, the diagnosis of burn damage to the respiratory tract does not cause problems. It is much more important and difficult to assess the depth and extent of internal tissue damage. In most cases, the diagnostic measures used are based on this.

• Laboratory tests – biochemistry and general blood analysis, general urine analysis – indicate the development of anemia and deterioration of kidney function. However, such changes do not occur immediately, but only on the 2-3 day after the injury.
• Instrumental diagnostics are performed using laryngoscopy and bronchoscopy. Bronchoscopy is considered a more informative diagnostic method for burns, as it allows for safe and urgent examination of the condition of all areas of the trachea and bronchi. Bronchoscopy makes it possible to clarify the nature of the lesion: it may be a catarrhal, necrotic, erosive or ulcerative burn of the respiratory tract.
• Differential diagnostics are carried out between chemical and thermal burns of the respiratory organs, as well as between damage to the mucous membranes of the respiratory and digestive tracts.

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Treatment respiratory burn

The prognosis of treatment directly depends on competent and timely emergency care for the victim. First aid for burns of the upper respiratory tract is carried out quickly and in stages:

• the victim is taken out into the fresh air or to a room where further exposure to the damaging agent is excluded;
• the patient is placed in a semi-recumbent position with his head raised (if he is unconscious, it is better to lay him on his side so that vomit does not enter the respiratory tract);
• the mouth and throat should be rinsed with water, possibly with the addition of novocaine or another anesthetic;
• in case of an acid burn, add a little baking soda to the rinse water;
• in case of alkali burn, it is recommended to add a little acetic or citric acid to the rinse water;
• then you should call an ambulance or take the victim to a medical facility yourself;
• During transportation or while waiting for a doctor, it is necessary to ensure that the patient maintains independent breathing. If there are no respiratory movements, then artificial respiration is used.

Treatment of chemical and thermal burns is practically no different. The goal of the treatment measures is usually the following:

• elimination of laryngeal swelling, ensuring normal respiratory function;
• prevention or treatment of shock and pain;
• relief of bronchial spasm;
• facilitating the release of accumulated secretions from the bronchi;
• prevention of pneumonia development;
• prevention of pulmonary collapse.

Intubation therapy is recommended at first.

The victim should not speak during treatment to avoid injury to the vocal cords (at least for 2 weeks).

The following medications are commonly used for treatment:

• Painkillers (Omnopon, Promedol).
• Non-steroidal anti-inflammatory drugs (Ibuprofen, Ketorol).
• Decongestant medications (Lasix, Triphas, Diacarb).
• Desensitizing drugs (Diphenhydramine, Diazolin, Diprazine).

For example, a standard doctor's prescription for a respiratory tract burn might look like this:

• Promedol intravenously, 1 ml of 1% solution for the first 2-3 days (Atropine can be prescribed simultaneously to prevent depression of the respiratory center);
• Ketolong intramuscularly from 10 to 30 mg with an interval of 8 hours (precautions: may cause pain in the stomach, dyspepsia, increased blood pressure);
• Triphas orally, 5 mg once daily (loop diuretic, may cause dry mouth, decreased blood pressure, metabolic alkalosis);
• Diprazine orally, 0.025 g up to 3 times a day (may cause drowsiness, dry mouth, dyspepsia).

If the doctor suspects burn damage to the lungs, then the introduction of infusion solutions, antibiotics, diuretics (to eliminate swelling) is mandatory. Intensive oxygen therapy is performed.

Surgical treatment may be recommended at later stages, when dermatoplasty may be required in relation to the affected tissues in the face, chest, and neck area.

To speed up tissue restoration and support the body's internal forces, vitamins are prescribed:

• Cyanocobalamin intramuscularly 200-400 mcg every other day for 2-3 weeks (be careful: may cause allergies, headaches, dizziness);
• Neurovitan – orally, 1 to 4 tablets/day. Duration of administration – up to 4 weeks (before starting administration, make sure there is no allergy to the components).

Physiotherapy may be used at the recovery stage. Physiotherapy is used to relieve pain and prevent infection of the burn surface. During the rehabilitation period, physiotherapy methods help to accelerate the removal of dead tissue and stimulate the formation of granulation and epithelium. In addition, this type of treatment improves skin engraftment during transplantation and prevents cicatricial changes in tissues.

In case of burns, it is recommended to use UFO of damaged mucous membranes and skin. As a method of pain relief, it is possible to use diadynamic currents. After surgical tissue transplantation, UFO is repeated in the transplantation area.

Traditional treatment of respiratory tract burns

It is worth noting right away that folk recipes can only be used for mild burns. And if the respiratory tract is damaged, it is almost impossible to independently determine the degree of damage. Therefore, contacting a doctor is mandatory.

For minor burn injuries to the mucous membrane, traditional healers recommend inhaling cool air to cool the irritated tissue.

It is also considered beneficial to consume liquid dairy products, especially kefir, yogurt, and sour cream.

Every time after eating, it is recommended to dissolve 1-2 teaspoons of natural honey in your mouth: this will speed up regeneration and relieve pain.

A burn of the respiratory tract will heal faster if you take 1 tablespoon of pumpkin or sea buckthorn oil three times a day. 6 drops of lavender oil diluted in 1 tablespoon of water will have the same effect. The medicine should be taken after meals.

Herbal treatment is usually combined with the main treatment: only in this case can a healing effect be expected.

Medicinal infusions based on coltsfoot, rose hips, and oak bark are very helpful in relieving pain. The listed plant components are ground and 1 tbsp. of the mixture is brewed in 250 ml of boiling water.

It is useful to drink cooled green tea, without sugar or other additives. Many people do not like the taste of green tea: in this case, the drink can be replaced with mint infusion.

A good effect on burns of the respiratory tract is given by a medicine prepared from mashed apples with carrot juice. Melted butter is added to the cooled mixture and taken in small quantities throughout the day.

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Homeopathy

Adherents of homeopathic treatment can use such drugs as a supplement to the main treatment prescribed by the doctor.

	Traumeel S
Dosage and method of administration	Intramuscular injection, 1 ampoule once a day. The same solution can be taken orally.
Special instructions and side effects	Requires caution if you are allergic to Asteraceae plants.

	Lymphomyosot
Dosage and method of administration	Take 15 drops three times a day 30 minutes before meals.
Special instructions and side effects	Not recommended for use in thyroid disease.

	Echinacea compositum
Dosage and method of administration	Intramuscular injection, 1 ampoule three times a week.
Special instructions and side effects	Caution: May cause an allergic reaction.

	Coenzyme compositum
Dosage and method of administration	Intramuscular injection, 1 ampoule up to 3 times a week.
Special instructions and side effects	Allergies are extremely rare.

	Mucosa compositum
Dosage and method of administration	In the form of intramuscular injections, 1 ampoule up to 3 times a week.
Special instructions and side effects	Do not use if you are allergic to phenol.

Homeopathic treatment for respiratory tract burns is usually continued for at least 4-5 weeks.

Prevention

A person who has suffered from respiratory tract burns must adhere to certain rules and restrictions in the future to avoid various complications and negative consequences.

• It is important to avoid colds and infectious respiratory diseases.
• Regularly visit a pulmonologist to monitor the condition of your respiratory system.
• Do not smoke under any circumstances and avoid inhaling smoke, vapors and chemical fumes.
• Spend more time outdoors and avoid physical inactivity.

As a rehabilitation, it is useful to do therapeutic physical training, undergo annual spa treatment. It is also necessary to monitor nutrition so that the body receives the maximum amount of nutrients and vitamins.

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Forecast

The prognosis for a burn injury can be considered favorable only if timely assistance is provided and all doctor’s instructions and recommendations are followed, including during the rehabilitation period.

A burn of the respiratory tract is a fairly serious injury that can remind of itself even after several years. Therefore, it is important to periodically visit a doctor and monitor the condition of the lungs, bronchi, and trachea in order to avoid respiratory dysfunction in the future.

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