Treating Lung Injuries in Burn Cases

Burns caused by catastrophic accidents are unique injuries that we deal with at our law firm. Burn injuries are painful and devastating to the body, but they also require extensive treatment by specialists. Lung damage presents serious complications, and thermal injuries are suffered in a fiery car crash. 

Burn injuries may result in severe pain, and they often leave permanent physical and emotional trauma along with life-long disabilities. If you or a loved one has suffered burns in an accident caused by someone else’s negligence, our experienced injury lawyers can assist you with your claim for damages. Call us for compassionate, free, and friendly advice at (916) 921-6400 or (800) 404-5400, or send your inquiry online.

When the human body is subject to flames and fire, the potential for injury to the respiratory tract exists. Often lung injuries of this type are associated with second-degree or third-degree burns to the face, but they can also be present when there are no burns and only the inhalation of hot fumes or steam. The degree of injury to the lungs depends on the following criteria:

• The intensity of the exposure
• The temperatures reached
• The chemical composition of the inhaled fumes
• The pre-existing conditions of the burned individual

In approximately fifteen to twenty percent of burn injury cases, the patient also sustains a respiratory injury. Such injuries require special medical care.

If there is an actual heat-related injury to the respiratory tract, it is usually confined to the mouth and upper throat. Damage related to smoke inhalation is usually the only issue that affects the areas below the vocal cords. There can be systemic effects throughout the body if the inhaled fumes contain a noxious substance or chemical that enters the bloodstream via the lungs.

Several complications may stem from inhalation injuries in burn victims. These include:

• A greater risk of death
• Poor air exchange into and out of the bloodstream
• Adult respiratory distress syndrome (RDS)
• Pneumonia
• Increased fluid requirements
• Pulmonary fibrosis
• Permanent lung damage

The treatment of lung injuries in burn patients is complex. It is often more difficult to treat lung injuries than treat the cutaneous burn itself. The difficulties may begin with the diagnosis. Even when the patient seems fine, it is essential to recognize that an inhalation injury likely occurred based on certain factors. In general, the longer the exposure time to the fire, the greater the chance of an inhalation injury.

An inhalation injury may be suspected if the following signs are present:

• Singed eyebrows or nose hairs
• Prolonged exposure to the fire
• Scald injuries in the mouth
• Black sputum
• Hoarseness or difficulty eating

A bronchoscopic evaluation of the trachea and upper bronchi may be performed if suspected inhalation injuries. This medical examination involves a tiny camera at the end of a long tube inserted into the patient’s airway. If soot or redness and swelling of the tissues in the mouth, trachea, or bronchi is observed, immediate intubation may be performed before continued swelling shuts off the airway completely.

When an inhalation injury happens, the mucosa of the membranes can slough off, causing fluid, also called exudate, to stream out of the tissue into the air passages. This eventually dries and adheres to the mucosa, interfering with airflow. There are several reasons why placing a burn patient on a ventilator earlier than later may be necessary. Signs that early intubation may be required include:

• Extensive burns to the face and neck
• Signs of airway blockage
• The need to place the patient into a medical-induced coma due to pain
• Respiratory failure
• Carbon monoxide or cyanide toxicity
• Burns to more than 40 percent body surface area
• Protection of the airway from aspiration of stomach contents
• Blood pressure instability

Intubation and management of the airway are often required with burns and inhalation injuries. It can, however, be done prematurely or unnecessarily. The necessity of the treatment should be considered carefully since intubation could further damage the airway and eliminate the patient’s ability to verbally communicate.

Inhalation injury can be worsened if chemicals are present in the inhaled fumes. It may be caustic to the lungs or poison the bloodstream depending on the chemical. Below are some common chemicals that may be present with inhalation injuries. 

• Carbon Monoxide. Carbon monoxide poisoning can occur from smoke inhalation. Carbon monoxide can bind to hemoglobin and stay on, preventing oxygen from binding to hemoglobin. The amount of carbon monoxide on the hemoglobin can be measured to gauge treatment. The best way to manage high carbon monoxide or CO levels is to provide 100 percent oxygen or even to use hyperbaric oxygen chambers where they are available.
• Cyanide. Cyanide poisoning may occur in situations where plastic has burned. The oxygen saturation will look normal, but the patient is still in respiratory distress. Doctors can also pick up on metabolic acidosis as a sign of cyanide toxicity. Treatment is best done as early as possible using oxygen and inhalation of amyl nitrate and/or other agents that counteract the effects of cyanide.

Below are the most commonly used treatments for inhalation injuries:

• Ventilator. Mechanical ventilation is often necessary for burn victims who have lung injuries. Patients with deeper injuries may require positive end-expiratory pressure ventilation (PEEP), which keeps the tiny air-exchanging alveoli in the lungs from collapsing with each breath.
• Extracorporeal Membrane Oxygenation (ECMO). Some patients with more severe lung injury need ECMO. In this intervention, blood is oxygenated outside of the body through a semipermeable membrane so that the lungs have a chance to rest and heal after a burn injury.

When intubation is used, the endotracheal tube will be removed when the burn patient is alert and shows little fluid in the lungs. Weaning off the ventilator is a gradual process. If the patient needs prolonged ventilation, a tracheostomy tube should be considered.

Watch the YouTube video. The video below, created by High Impact, discusses respiratory injuries caused by toxic chemicals. 

Burns injuries are a medical emergency, and sometimes they lead to infections and other life-altering complications, such as lung injuries. If you have suffered this type of injury due to someone else’s negligence, call our injury lawyers today for free, friendly case advice at (916) 921-6400 or (800) 404-5400. We have successfully handled burn injury cases and are knowledgeable about the complexities involved with such injuries. 

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Editor’s Note: This page has been updated for accuracy and relevancy [cha 5.31.22]

Image by Sharon McCutcheon from Pixabay 

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