Burning of the respiratory tract

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

[1], [2], [3], [4], [5], [6]

Epidemiology

The greatest number of cases of airway burns was observed during the wars: during these periods, the frequency of thermal lesions increased significantly, from 0.3% to 1.5% of the total number of victims. This is due to the massive use of explosives, combustible mixtures and thermal weapons.

In modern times, the frequency of burns, unfortunately, increases. For example, only in Israel, as a result of military conflicts, burn injuries ranged from 5% to 9%. With the use of tanks and motorized transport, the percentage can be increased to 20-40%.

In domestic conditions, the number of airway burns is significantly lower and is less than 1% of all burns.

[7], [8], [9], [10], [11], [12], [13], [14], [15]

Causes of the burn of respiratory tract

Burns of respiratory organs can be provoked:

• chemical evaporation;
• high temperature.

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

Chemical burns can be obtained at the factory, in case of accidental damage to tanks with evaporating liquid. The sharp inhalation of such fumes often leads to internal tissue damage. In addition, it is possible to inhale corrosive smoke during a fire. If such smoke contains phosgene, hydrocyanic or nitrous acid, or other toxic substances, then a respiratory burn is imminent.

Thermal damage to the respiratory system is observed when breathing hot steam or air, or even flame tongues.

[16], [17], [18], [19], [20]

Pathogenesis

The pathogenesis of the respiratory tract burn consists in the thermal or chemical destruction of mucous and submucosal tissues with a violation of their function. The degree of damage can be different, depending on the temperature and duration of exposure, on the depth of inspiration when the injuring agent hits. If the burn is significant, then deep tissue necrosis can occur, which can cover several layers.

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

[21], [22], [23], [24], [25], [26], [27], [28]

Symptoms of the burn of respiratory tract

The first signs of a burn of respiratory organs appear immediately after the impact of the damaging factor. To indicate the presence of a burn may be such circumstances as a fire in an apartment, a utility room, in a mine, in transport, as well as a short-term effect of steam or open fire (especially if a chest, neck or facial burn is simultaneously present).

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

Visually, it is possible to detect skin damage in the region of the lips, and the oral mucosa is swollen and hyperemic. In severe cases, as a result of damage to the external laryngeal ring, laryngeal stenosis and suffocation can develop.

Stages of burns	Symptoms			Complications
	Cyanosis	Chroches in the lungs	Coughing, expectoration, unrecognizability of the voice	Respiratory-heart failure	Pneumonia
I stage (burn oral mucosa, epiglottis, larynx). II stage (burn damage of II and III degree of respiratory organs).	It happens rarely. It is sharply expressed.	Unexpressed, dry rales. A large number of dry wheezes, which after 2-3 days become wet and pass into crepitation.	Uncharacteristic. A frequent dry cough, from 2-3 days sputum is allocated. The voice is hoarse, aphonia is possible.	No. Often occurs on day 2-3.	Occasionally, it has a favorable current. It develops in almost all cases. The current is heavy.

[29], [30], [31], [32], [33]

Forms

Depending on which factor caused the defeat of the respiratory system, different types of such injuries are distinguished. All of them differ, first of all, by clinical symptoms.

• Chemical burns of the respiratory tract can be suspected with the simultaneous presence of chemical damage to the skin of the neck, face, chest, in the mouth. The victim often has breathing problems, his voice changes, bloody vomiting, coughing with dirty discharge.
• The burn of the respiratory tract with chlorine is accompanied by a sensation of sharp burning in the throat, nasal cavity and behind the breastbone. At the same time, there may be lacrimation, a strong frequent cough and toxic rhinitis. The mucous airway remains irritated for several days after the cessation of the damaging factor.
• The burn of the respiratory tract with acid can be determined by the state of the posterior pharyngeal wall. In most cases, the mucosa on it first turns white or turns yellow, then it becomes dirty green and then almost black. A crust forms on the surface, which bleeds when it is rejected.
• Burning of the respiratory tract with a couple of colors causes swelling of the nasopharynx, sneezing, coughing. The victim complains of shortness of breath and difficulty breathing. Skin covers are pale, eyes turn red. Often there is pain in the head and dizziness.
• Thermal burn of the respiratory tract is accompanied by shortness of breath, blue skin, changes in the voice. When examined, you can see obvious burns to the pharynx and the upper sky. The patient displays anxiety, fear, which is often associated with severe pain and difficulty breathing. In severe cases, loss of consciousness occurs.
• The burn of the respiratory tract during a fire is most typical. For such an injury is characterized by damage to the lips, neck, mouth. When viewed, the burned inner surface of the nostrils is observed. When examining the secret from the bronchi, the nasal cavity can detect traces of soot.
• Burning of the respiratory tract with steam is usually accompanied by laryngospasm, without significant damage to the trachea, bronchi and lungs. The fact is that when a hot steam is inhaled, a protective reaction is triggered in the form of involuntary contraction of the muscles of the larynx. Therefore, this type of burn can be considered the most favorable.

[34], [35], [36], [37], [38]

Complications and consequences

Light burns of respiratory tract I st. Usually do not cause negative consequences and are cured without special problems.

At the II or III st. Burn injury can develop complications with fairly negative predictions.

Among the most unfavorable complications are the following:

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

[39], [40], [41], [42], [43], [44], [45]

Diagnostics of the burn of respiratory tract

Usually the diagnosis of burns to the respiratory tract does not cause problems. It is much more important and more difficult to assess the depth and scale of internal tissue damage. On this in most cases and based diagnostic measures are used.

• Laboratory tests - biochemistry and a general blood test, a general analysis of urine - indicate the development of anemia and impaired renal function. However, such changes do not occur immediately, but only 2-3 days after injury.
• Instrumental diagnosis is performed with the help of laryngoscopy and bronchoscopy. A more informative diagnostic method for burns is bronchoscopy, which allows you to safely and urgently check the condition of all tracheal and bronchial sites. Bronchoscopy makes it possible to clarify the nature of the lesion: it can be a catarrhal, necrotic, erosive or ulcerative burn of the respiratory tract.
• Differential diagnosis is carried out between chemical and thermal burns of respiratory organs, as well as between damage to the mucosa of the respiratory and digestive tracts.

[46], [47], [48], [49], [50], [51]

Treatment of the burn of respiratory tract

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

• the victim is taken to fresh air, or into a room in which the further action of the damaging agent is excluded;
• the patient is given a half-lying position with an elevated head part (if he is unconscious, it is better to put him on the side so that the vomit will not enter the respiratory tract);
• the mouth and throat should be rinsed with water, can be added with novocaine or another anesthetic;
• at an acid burn in water for a rinse it is necessary to add a little bit of baking soda;
• with an alkaline burn in rinse water it is recommended to add a little acetic or citric acid;
• further, it is necessary to call "emergency aid", or independently deliver the victim to the medical institution;
• During transportation or waiting for the doctor, care must be taken to ensure that the patient remains independent breathing. If there are no respiratory movements, then resort to artificial respiration.

Treatment of chemical and thermal burn injuries is practically the same. The goal of the ongoing treatment is usually the following:

• elimination of edema of the larynx, ensuring normal breathing function;
• prevention or treatment of shock and pain;
• removal of bronchospasm;
• relief of the escape from the bronchi of accumulated secretions;
• prevention of pneumonia;
• prevention of pulmonary collapse.

Initially, intubation therapy was recommended.

The victim during treatment should not talk, to avoid trauma to the vocal cords (at least within 2 weeks).

The following medicines are commonly used for treatment:

• Anesthetics (Omnupon, Promedol).
• Anti-inflammatory non-steroid agents (Ibuprofen, Ketorol).
• Antidiarrheal medicines (Lasix, Trifas, Diakarb).
• Desensitizing drugs (diphenhydramine, diazolin, diprasine).

For example, the standard appointment of a doctor for burns of the respiratory tract may look like this:

• Promedol in / in 1 ml of 1% solution for the first 2-3 days (atropine can be prescribed simultaneously to prevent oppression of the respiratory center);
• Ketolong IM / 10 to 30 mg with an interval of 8 hours (precautions: can cause pain in the stomach, dyspepsia, high blood pressure);
• Trifas orally, 5 mg once a day (loop diuretic, can cause dry mouth, lower blood pressure, metabolic alkalosis);
• Diprazin orally, to 0.025 g to 3 times a day (it may cause drowsiness, dry mouth, dyspepsia).

If the doctor suspects burn damage to the lungs, then mandatory introduction of infusion solutions, antibiotics, diuretics (to eliminate puffiness). Carried out intensive oxygen therapy.

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

To quickly restore tissue and support the body's internal forces, vitamins are prescribed:

• Cyanocobalamin I / m 200-400 mcg every other day for 2-3 weeks (caution: may cause allergies, headache, dizziness);
• Neurovitan - inside, from 1 to 4 tab. / Day. Duration of admission - up to 4 weeks (before the beginning of the reception, you should make sure that there is no allergy to the components).

At the restoration stage, the use of physiotherapy is possible. Physiotherapeutic treatment is used to anesthetize and prevent infection of the burn surface. During rehabilitation, the methods of physiotherapy allow to accelerate the passage of dead tissue and stimulate the formation of granulation and epithelium. In addition, this type of treatment improves the engraftment of the skin during transplantation, and also prevents scar tissue changes.

When burns are recommended, use UV damage to the mucous membranes and skin. As an anesthetic method, it is possible to use diadynamic currents. After surgical transplantation, the UFO is repeated in the transplantation zone.

Alternative treatment of airway burns

It should be noted immediately that alternative recipes can be applied only with mild burns. And with damage to the respiratory tract, it is almost impossible to determine the degree of damage independently. Therefore, a doctor must be compulsory.

With small burns of the mucosa, alternative healers recommend breathing in cool air, cooling the irritated tissues.

It is also considered useful to use liquid dairy products, especially kefir, curdled milk, sour cream.

Every time after a meal it is recommended to dissolve in the mouth 1-2 tsp. Natural honey: this will speed up the regeneration and soothe the pain.

The burn of the respiratory tract will heal faster if three times a day take 1 tbsp. Spoon of pumpkin or sea-buckthorn oil. The same action will have 6 drops of lavender oil, diluted in 1 tbsp. L. Water. The medicine should be taken after meals.

Treatment with herbs is usually combined with the main treatment: only in this case one can expect a healing effect.

Very helpful in the removal of pain medicinal infusions based on mother-and-stepmother, dog rose, oak bark. The listed plant components are ground and brewed 1 tbsp. L. Mixture in 250 ml of boiling water.

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

A good effect for burns of the respiratory tract is given by a medicine made from mashed apples with carrot juice. In the cooled mixture add melted butter and take during the day in small quantities.

[52], [53], [54], [55], [56]

Homeopathy

Adherents of homeopathic treatment can use such drugs as a supplement to the main treatment that the doctor will appoint.

	Traumeel C
Dosage and route of administration	Injection intramuscularly, 1 ampoule once a day. The same solution can be taken orally.
Special instructions and side effects	It requires caution in the presence of allergies to Compositae plants.

	Lymphomyositis
Dosage and route of administration	Take 15 drops three times a day for 30 minutes before meals.
Special instructions and side effects	It is not recommended to take with diseases of the thyroid gland.

	Echinacea compositum
Dosage and route of administration	Injection intramuscularly, 1 ampoule thrice a week.
Special instructions and side effects	Caution: may cause an allergic reaction.

	Coenzyme compositum
Dosage and route of administration	Injection intramuscularly for 1 ampoule up to 3 times a week.
Special instructions and side effects	Allergy is extremely rare.

	Mucosa compositum
Dosage and route of administration	In the form of intramuscular injections, 1 ampoule up to 3 times a week.
Special instructions and side effects	Do not use for allergies to phenol.

Homeopathic treatment for airway burns usually lasts no less than 4-5 weeks.

Prevention

Burned airway burns in the future must adhere to some rules and restrictions to avoid various complications and negative consequences.

• It is important to avoid catarrhal diseases, infectious respiratory diseases.
• Regularly visit a doctor-pulmonologist to monitor the state of the respiratory system.
• Do not smoke, and avoid inhaling smoke, fumes and chemical fumes.
• It is more common to be outdoors, to avoid hypodynamia.

As rehabilitation it is useful to engage in physical therapy, annually to conduct sanatorium-and-spa treatment. It is also necessary to monitor the diet so that the body receives the maximum amount of nutrients and vitamins.

[57], [58], [59], [60], [61], [62], [63], [64]

Forecast

The prognosis of burn injury can be considered favorable only on condition of timely assistance and compliance with all prescriptions and recommendations of the doctor, including during the rehabilitation period.

The burn of the airways is a serious enough injury that can remind of yourself in a few 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 disturbances in the future.

[65], [66], [67], [68]