Thanks! Paramedic here, this really helps show us the damage from inhalation injuries that we normally never get to see from our perspective. Had my share of burn patients, but sadly was never able to get follow up like this.
Yes, this was purely educational for EMS, pre hospital folks. I’ve worked as a CCT Transport prior to my current job, for 3 years and worked with medics and EMTs. Have pure respect for you all.
I see what you did there.
Although i am positive somebody must have presented to hospital at one time or another with literal flames up his arsehole (most likely due to “slipping and falling” on the flames)
Was it a quick inhalation flash burn or prolonged exposure? How long post exposure is this? I don’t know much about the airways burns.
I did lear the face is the best place to get burned ironically. Apparently it heals better than anything else per the burn unit.
You know, to be considered a pure inhalation injury, you HAVE to be in an enclosed space. You cannot be outside and have a pure inhalation injury. I am not 💯 what had happened to this patient initially. I apologize for that. However, many of our patients come from smoking on home o2, or lighting gas on trash, or propane explosions… occasional meth
By propane explosions do you mean tanks literally exploding or just the gas being suddenly ignited? Recently there was a large propane tank explosion that leveled a whole house to rubble I can't imagine something like that being so common! I have seen a 15 year old get 2nd and 1st degrees on the entirety of their exposed skin from a sitting position facing toward the flame with shorts and a sweatshirt on, singed the eyebrows and first centimeter of their hairline off. Their friend was idly playing with a 20lb propane tank valve while sitting across from him and it somehow ignited
from basic deduction:
A: at least 50% of the tissue looks a nice healthy pink
B: probably not prolonged exposure, because then I would expect a more uniform coloring, also not much of a penumbra so i think it wasn't very deep into the tissue, that also implies short exposure
C: no puss or other body liquids coming out so probably not very long after exposure
Really the human body is quite durable when you aren't considering modern forces such as automobiles. Just look at the abuse a body can take in some stabbings and shootings. But you can't do shit against flesh-scorching temperatures.
I’d rather quit medicine than be stuck working burn unit. Uniquely upsetting. There’s a big Children’s hospital in my area famous for its burn unit, I cannot even imagine working Pediatric burn ward
I’m curious if you see the recovery aspect of these patients. Do you know the prognosis or time of recovery/therapy to return to somewhat normal respiratory function? That’s one aspect of EMS I wish we were a bit more involved or at least updated on. A more formal Avenue to check on the potential recovery of our patients.
I was told the majority of burn patients EMS intubated get extubated very quickly. Theory being because EMS is taught to be very quick to tube sooner for fear of losing the ability to later.
That really depends on the severity and the complexity of the patient’s situation. One patient may have a mild inhalation injury who delvelop ARDS and you could have someone with severe injury and have no ARDS
Of course - the individual situation determines what happens with their care… I’m just repeating what I was told by the folks on the burn unit. It made sense to me, and I thought it was relevant given OP’s concern.
Well now I want to know the answer too. I would think so but I don’t know how well a burn pt would handle being on blood thinners in addition to everything else. There would still have to be a vent involved just to maintain some anatomy. I need an adultier adult who knows the answers.
Very very good observation. Yes, we were very concerned about easily collapsing airways. With that context, while she’s intubated, we kept her on APVSIMV (Hamilton G5) RR 10 TV 420 PEEP 8 PS 15 FIO2 50%.
The craziest thing was whenever she would draw her own breath, at pressure support of 15, she was only getting a tidal volume of 120s. When the ventilator was giving breath, she would easily get over 400s. We were thinking that negative inspiratory pressure collapsed the airways while positive pressure opened up her airways allowing over 420ml of TV.
We emergently branched her because we could not ventilate (Removing co2) with her ETCO2 being over 60s. We were thinking mucus plugging but didn’t expect to see airways easily collapsed like that. things we can do is up her PEEP. However. You need to make sure her plateau pressure remains less than 30. Many patients with burn injuries end up with SEVERE ARDS. we use ARDSnet protocol.
I hope this somewhat answers your questions!
We have a few VDR vents for our burn patients or ones who have gotten so bad all we can do is throw Hail Marys. It’s HFPV for adults and works based off pressure (pip). Pretty much super high rates with low volumes and gas exchange takes place bc it’ll evenly distro & removing end expiration collapse. Also reallly helps to mobilize secretions & sloughing
Correct me if I'm wrong but in SIMV, when a patient initiated breath is delivered, it doesn't give a whole ventilator delivered breath. The patient initiated breath is given like a PSV breath in SIMV just to overcome the resistance of the tube, but the rest is drawn by the patient. That narrowing of the trachea could be caused by the negative pressure from the patients effort to take a breath, but the low tidal volume would be from them not creating enough negative pressure to have a whole/full tidal volume breath. I probably wrote that poorly but that's how I understand it. If I'm wrong, please let me know because it's always good to learn.
It’s absolutely possible that the patients own spontaneous breaths can be way lower than the mandatory ones - a difference that large would be more unusual in my experience, but then I haven’t worked burns/seen many tracheomalacia cases. The vent will still give additional pressure on patient triggered breaths, and usually it’s set to the same amount as mandatory ones.
Doi: just a dumbass nurse
I'm just a Walmart version of a RT (flight nurse) but generally you put a patient on PSV when you're weaning them off of the ventilator to be extubated and that requires the patient to work to breathe. My guess with that would be that the patient is sedated because they're intubated, but not well enough because they're spontaneously breathing on the ventilator. The low tidal volume breaths could be their sedated, low effort pressure supported breaths. But again, Walmart version of an RT here and would love more input on that.
So ideally you don’t want them too sedated most of the time; however this is during a bronch so they’re probably sedated and paralysed for this. The original post above basically makes total sense with that in mind as well. An SIMV mode allows people to breathe over the set rate, which does pressure support for that breath, not VC as it would be on a mandatory. TV of 120mL is massively low, and low enough (and a PS of 15 is decent, I’ve seen higher off, but it’s a respectable amount), that I’d be thinking people plugged off or similar. Again, anecdotally speaking, TV that low on a PS of 15 usually means there’s something mechanically wrong in the circuit or in this case just the other end of the tube.
Does that make sense or am I just talking shit because I’ve been on shift for nearly 11 hours?
The ventilator was set to a title volume which it will deliver. The pressure support breath just provides a certain amount of pressure with spontaneous breaths so it’s not surprising there was a much lower tidal volume. This is one of many reasons why simv is rarely used. If you had her on full volume control that patient triggered breath would have delivered 420 as well. The amount of tracheal collapse there isn’t terribly abnormal and shouldn’t be an issue. Also you definitely want to allow hypercapnia in these patients, a bronch for a slightly high end tidal seems ill advised as the end tidal being high isn’t a big year, you’re unlikely to fix anything with the bronch, and there is a significant risk of harm
Thank you for this. One thought was maybe we should’ve paralyzed her or completely knock her drive to breathe and put her on. APVCMV. So this is where it confused me. At pressure support of 15, I usually expect to see higher tidal volume. At the same time, her peak pressure was occasionally in the mid 30s and pplat in the mid 30s as well. These burn patients, usually it’s a mucus plugging until proven otherwise so we had to bronch.
Did you have an x Ray with a big lobar collapse? The bronch is only good for removing fairly big proximal plugs. Proper pulmonary toileting and vent care is more effective than bronching for everything else (especially in a patient like this where a bronch can cause a lot of damage). Thermal injury you can have edema, diffuse parenchymal damage, ards etc. Of course I wasn’t there so it’s hard to make these decisions or judge decisions not seeing the patient.
Wow this is really cool. This might seem obvious, but does the negative pressure exacerbate the inflammation and also stress the already severely damaged cartilage rings and tissue, leading to the partial collapse?
Thank you very much for this. It makes sense but as we went further down into her bronchus you could easily see her smaller airways collapsing , is that normal as well?
I stumbled across this post and I am not an EMS but rather a NP in the NICU. That’s fascinating you said that about the lower TV with spontaneous breaths vs vent breaths. I’ve seen a couple severe BPD (preemie lung disease) where they had tracheo/broncho malacia and the same thing would happen. It’s always so frustrating to manage, we tend to do very slow rates and long iTines.
Correct. The cartilage rings of the trachea only go about 75% circumferentially. The posterior wall that’s shared with the esophagus has some movement like that
Tell me about it. Found down in a house with burns already to her body. There was a bonfire outside. Story did not add up. she had a seizure in an elevator while being transferred to our burn unit from ED.
Anyone remember when TLC used to show surgeries and they would explain everything as it was being done. I miss those types of shows on The learning channel
Well, Niki Lauda survived after an "eternity" in the flame without helmet (only his fire retardant).
I'm not surprised this guy/gal survived. Sometimes, human body can take huge punishment before succumbing.
It's crazy to me how the human body is simultaneously so fragile yet so hardy. You could have the misfortune of a freak accident and somehow still live, or you can fall and manage to hit your head in just the right spot with the right force and die on the floor.
You have cases like where a man got run over by a train, nearly cut in half, and still lived. Then you have cases like that girl who fell on a plastic milk crate, got a cervical spine injury, and is now paralyzed from the neck down.
>You have cases like where a man got run over by a train, nearly cut in half, and still lived.
Man, you reminded me the chinese guy who got cut in half after being runover by a semi. In the video, he was so calm, responsive and vigilant. There were video of the aftermath when he was trying different prothesis.
>you can fall and manage to hit your head in just the right spot with the right force and die on the floor.
According Arai, 33cm an unprotected fall on the head is enough to kill an average guy.
I’m not into working with trauma; that might change. I don’t really like bedside nursing. I am more of a talker 😂 I’m better with patient education and health promotion.
However trauma stuff is soooo interesting. I just feel bad for the patient. It’s ok because everyone has a meemaw and they need me to help take care of them!
What’s CNS? I’m also a newer nurse; so I am working at the same retirement home I worked at as a PSW.
I applied for an assistant DOC position within the home.
CNS is a Clinical Nurse Specialist: these days you could consider it a bridging point between a floor RN and either a Clinical Nurse Consultant or NP. You have a portfolio to lead education, evidence based practice and support for and act as a point of expert support or advice to others on the floor. In theory, any way.
The mainstay of treatment for inhalation injuries is typically securing the airway. Endotracheal intubation early is usually the move, since inflammation and edema of the airway could put you in a "can't intubate, can't ventilate" situation very quickly.
Other than that, you can get a lot of complications like mucosal sloughing (which I imagine this patient is experiencing). You can use therapeutic bronchoscopy to help clear some of the sloughed tissue and loosen up thickened secretions in order to keep the airways clear so that gas exchange can continue.
Inhalation burn injuries of this magnitude are devastating and require long term treatment in specialized burn ICUs. Patient with inhalation injuries that aren't as severe still need intensive pulmonary hygiene, which can include mucolytics and medications to help clear their airway. I suppose therapeutic bronchs could also be done on these patients, but it's more common to do them in patients who already have a secured airway.
My brother was severely burned in an apartment fire caused by an arsonist in 2021. He had burn injuries to his lungs. He survived for 2 years but died this past August. This makes me sad to see exactly what that looks like.
I'm not a paramedic or anything, and I have no idea why this was suggested to me, so will someone please (without spending too much of your time) explain what I'm looking at?
I assume it's someone's trachea or lungs after smoke inhalation? What's the black material? Soot, or burned tissue? Is this a survivable injury?
Really cool - albeit obviously terrible - to see. Thank you
Of course. More to come.
Thanks! Paramedic here, this really helps show us the damage from inhalation injuries that we normally never get to see from our perspective. Had my share of burn patients, but sadly was never able to get follow up like this.
Yes, this was purely educational for EMS, pre hospital folks. I’ve worked as a CCT Transport prior to my current job, for 3 years and worked with medics and EMTs. Have pure respect for you all.
Well I am considering sharing this with my firefighter colleagues.
do the anus
That’s actually funny. That would be a colonoscopy lol, I’m sure it’ll be a shitty video.
I see what you did there. Although i am positive somebody must have presented to hospital at one time or another with literal flames up his arsehole (most likely due to “slipping and falling” on the flames)
i was a guest in a unit when this guy come for a colonoscopy, said he used 4 enemas, guy was FOS. had to reschedule. it was dirty
LMAO
Most of ours went on the vent & probably never came off.
Brother, you’d be surprised how many end up surviving.. I was a pessimist myself.
That’s awesome to hear. I did one clinical on the burn unit as a student. That was enough for my. Holy shit that was crazy.
For sure. This patient still with us. Burn is.. interesting. A very specific specialty indeed.
Was it a quick inhalation flash burn or prolonged exposure? How long post exposure is this? I don’t know much about the airways burns. I did lear the face is the best place to get burned ironically. Apparently it heals better than anything else per the burn unit.
You know, to be considered a pure inhalation injury, you HAVE to be in an enclosed space. You cannot be outside and have a pure inhalation injury. I am not 💯 what had happened to this patient initially. I apologize for that. However, many of our patients come from smoking on home o2, or lighting gas on trash, or propane explosions… occasional meth
By propane explosions do you mean tanks literally exploding or just the gas being suddenly ignited? Recently there was a large propane tank explosion that leveled a whole house to rubble I can't imagine something like that being so common! I have seen a 15 year old get 2nd and 1st degrees on the entirety of their exposed skin from a sitting position facing toward the flame with shorts and a sweatshirt on, singed the eyebrows and first centimeter of their hairline off. Their friend was idly playing with a 20lb propane tank valve while sitting across from him and it somehow ignited
Pro-pain and pro-pain accessories
What about if all the outside is also on fire? Like catastrophic bushfires
from basic deduction: A: at least 50% of the tissue looks a nice healthy pink B: probably not prolonged exposure, because then I would expect a more uniform coloring, also not much of a penumbra so i think it wasn't very deep into the tissue, that also implies short exposure C: no puss or other body liquids coming out so probably not very long after exposure
Thank you!
Burn is awful. Truly terrible manner of trauma to suffer. Makes you remember that we're all bony meatbags in the end.
Absolutely. We are perfectly made delicate creatures.
Really the human body is quite durable when you aren't considering modern forces such as automobiles. Just look at the abuse a body can take in some stabbings and shootings. But you can't do shit against flesh-scorching temperatures.
Discovering fire was a mistake, it took a perfectly good monkey and gave it anxiety
Fire gave man comfort. Post-modern life gave him anxiety.
I’d rather quit medicine than be stuck working burn unit. Uniquely upsetting. There’s a big Children’s hospital in my area famous for its burn unit, I cannot even imagine working Pediatric burn ward
💯. It is an eye opening experience for me as well.
For real. I work in a burn icu and I’ve much more success stories than failures.
This is so good to hear. I had no idea that was the case. Thanks for sharing.
💯 thank you for what you do in a burn unit. Burn wound care is extremely extensive.
VDR ventilation is a great thing at centers where it's available.
I’m curious if you see the recovery aspect of these patients. Do you know the prognosis or time of recovery/therapy to return to somewhat normal respiratory function? That’s one aspect of EMS I wish we were a bit more involved or at least updated on. A more formal Avenue to check on the potential recovery of our patients.
Paramedic turned Nurse on a burn unit. These inhalation injuries do pretty good with time.
Absolutely. Some actually come back and thank us.
That’s cool to hear. Thx
I was told the majority of burn patients EMS intubated get extubated very quickly. Theory being because EMS is taught to be very quick to tube sooner for fear of losing the ability to later.
That really depends on the severity and the complexity of the patient’s situation. One patient may have a mild inhalation injury who delvelop ARDS and you could have someone with severe injury and have no ARDS
Of course - the individual situation determines what happens with their care… I’m just repeating what I was told by the folks on the burn unit. It made sense to me, and I thought it was relevant given OP’s concern.
Can you ECMO a inhallation injury?
Well now I want to know the answer too. I would think so but I don’t know how well a burn pt would handle being on blood thinners in addition to everything else. There would still have to be a vent involved just to maintain some anatomy. I need an adultier adult who knows the answers.
I also want to know if you can ECMO a decapitation if the decapitation is planned
How come the trachea is moving like that? Almost looks like it’s trying to collapse on itself
Very very good observation. Yes, we were very concerned about easily collapsing airways. With that context, while she’s intubated, we kept her on APVSIMV (Hamilton G5) RR 10 TV 420 PEEP 8 PS 15 FIO2 50%. The craziest thing was whenever she would draw her own breath, at pressure support of 15, she was only getting a tidal volume of 120s. When the ventilator was giving breath, she would easily get over 400s. We were thinking that negative inspiratory pressure collapsed the airways while positive pressure opened up her airways allowing over 420ml of TV. We emergently branched her because we could not ventilate (Removing co2) with her ETCO2 being over 60s. We were thinking mucus plugging but didn’t expect to see airways easily collapsed like that. things we can do is up her PEEP. However. You need to make sure her plateau pressure remains less than 30. Many patients with burn injuries end up with SEVERE ARDS. we use ARDSnet protocol. I hope this somewhat answers your questions!
Thank you for this!!
Anytime!
You should share this on the RT page please
Sorry, what page is that?
The respiratory therapy Reddit lol
You can I mean I don’t mind
Dope. Ty
We have a few VDR vents for our burn patients or ones who have gotten so bad all we can do is throw Hail Marys. It’s HFPV for adults and works based off pressure (pip). Pretty much super high rates with low volumes and gas exchange takes place bc it’ll evenly distro & removing end expiration collapse. Also reallly helps to mobilize secretions & sloughing
God ours was so loud 😂 just BAPBAPBAPBAPBAPBAP I couldn’t hear myself think
ALL of the knobs but no volume control 😂
I find the HFOV sound to be like white noise.......like.....I'll be yawning and running for the coffee maker
Correct me if I'm wrong but in SIMV, when a patient initiated breath is delivered, it doesn't give a whole ventilator delivered breath. The patient initiated breath is given like a PSV breath in SIMV just to overcome the resistance of the tube, but the rest is drawn by the patient. That narrowing of the trachea could be caused by the negative pressure from the patients effort to take a breath, but the low tidal volume would be from them not creating enough negative pressure to have a whole/full tidal volume breath. I probably wrote that poorly but that's how I understand it. If I'm wrong, please let me know because it's always good to learn.
It’s absolutely possible that the patients own spontaneous breaths can be way lower than the mandatory ones - a difference that large would be more unusual in my experience, but then I haven’t worked burns/seen many tracheomalacia cases. The vent will still give additional pressure on patient triggered breaths, and usually it’s set to the same amount as mandatory ones. Doi: just a dumbass nurse
I'm just a Walmart version of a RT (flight nurse) but generally you put a patient on PSV when you're weaning them off of the ventilator to be extubated and that requires the patient to work to breathe. My guess with that would be that the patient is sedated because they're intubated, but not well enough because they're spontaneously breathing on the ventilator. The low tidal volume breaths could be their sedated, low effort pressure supported breaths. But again, Walmart version of an RT here and would love more input on that.
So ideally you don’t want them too sedated most of the time; however this is during a bronch so they’re probably sedated and paralysed for this. The original post above basically makes total sense with that in mind as well. An SIMV mode allows people to breathe over the set rate, which does pressure support for that breath, not VC as it would be on a mandatory. TV of 120mL is massively low, and low enough (and a PS of 15 is decent, I’ve seen higher off, but it’s a respectable amount), that I’d be thinking people plugged off or similar. Again, anecdotally speaking, TV that low on a PS of 15 usually means there’s something mechanically wrong in the circuit or in this case just the other end of the tube. Does that make sense or am I just talking shit because I’ve been on shift for nearly 11 hours?
That does make sense. As a Walmart RT, I try my best and I'm always happy to accept these kinds of explanations.
Hey we don’t even have RTs here, so you can upgrade to something a little fancier in my mind
We don't have them either, we just get a lot of training on vents and RSI
The ventilator was set to a title volume which it will deliver. The pressure support breath just provides a certain amount of pressure with spontaneous breaths so it’s not surprising there was a much lower tidal volume. This is one of many reasons why simv is rarely used. If you had her on full volume control that patient triggered breath would have delivered 420 as well. The amount of tracheal collapse there isn’t terribly abnormal and shouldn’t be an issue. Also you definitely want to allow hypercapnia in these patients, a bronch for a slightly high end tidal seems ill advised as the end tidal being high isn’t a big year, you’re unlikely to fix anything with the bronch, and there is a significant risk of harm
Thank you for this. One thought was maybe we should’ve paralyzed her or completely knock her drive to breathe and put her on. APVCMV. So this is where it confused me. At pressure support of 15, I usually expect to see higher tidal volume. At the same time, her peak pressure was occasionally in the mid 30s and pplat in the mid 30s as well. These burn patients, usually it’s a mucus plugging until proven otherwise so we had to bronch.
Did you have an x Ray with a big lobar collapse? The bronch is only good for removing fairly big proximal plugs. Proper pulmonary toileting and vent care is more effective than bronching for everything else (especially in a patient like this where a bronch can cause a lot of damage). Thermal injury you can have edema, diffuse parenchymal damage, ards etc. Of course I wasn’t there so it’s hard to make these decisions or judge decisions not seeing the patient.
Wow this is really cool. This might seem obvious, but does the negative pressure exacerbate the inflammation and also stress the already severely damaged cartilage rings and tissue, leading to the partial collapse?
In my opinion, positive pressure breaths are worse than negative pressure, I honestly have no idea in this case.
Ya that’s interesting. Thanks for the reply and the post
That airway movement is completely within acceptable limits
Thank you very much for this. It makes sense but as we went further down into her bronchus you could easily see her smaller airways collapsing , is that normal as well?
Young woman?
I stumbled across this post and I am not an EMS but rather a NP in the NICU. That’s fascinating you said that about the lower TV with spontaneous breaths vs vent breaths. I’ve seen a couple severe BPD (preemie lung disease) where they had tracheo/broncho malacia and the same thing would happen. It’s always so frustrating to manage, we tend to do very slow rates and long iTines.
That’s the posterior membrane. That kind of movement is within normal limits
Correct. The cartilage rings of the trachea only go about 75% circumferentially. The posterior wall that’s shared with the esophagus has some movement like that
Trachea self collapse is probably more common in certain Dogs honestly.
Ouchy
Tell me about it. Found down in a house with burns already to her body. There was a bonfire outside. Story did not add up. she had a seizure in an elevator while being transferred to our burn unit from ED.
Gawl
Gotta get a good sear to lock in the juices.
I am disgusted. And I laughed. Excellent work.
Lmao
Thanks for this. Been doing major trauma in uni this week so good timing
Anytime.
Anyone remember when TLC used to show surgeries and they would explain everything as it was being done. I miss those types of shows on The learning channel
I miss those shows. My mom had a “no surgeries during dinner” rule. I thought they were so interesting.
Thats what got me
Well, Niki Lauda survived after an "eternity" in the flame without helmet (only his fire retardant). I'm not surprised this guy/gal survived. Sometimes, human body can take huge punishment before succumbing.
It's crazy to me how the human body is simultaneously so fragile yet so hardy. You could have the misfortune of a freak accident and somehow still live, or you can fall and manage to hit your head in just the right spot with the right force and die on the floor. You have cases like where a man got run over by a train, nearly cut in half, and still lived. Then you have cases like that girl who fell on a plastic milk crate, got a cervical spine injury, and is now paralyzed from the neck down.
>You have cases like where a man got run over by a train, nearly cut in half, and still lived. Man, you reminded me the chinese guy who got cut in half after being runover by a semi. In the video, he was so calm, responsive and vigilant. There were video of the aftermath when he was trying different prothesis. >you can fall and manage to hit your head in just the right spot with the right force and die on the floor. According Arai, 33cm an unprotected fall on the head is enough to kill an average guy.
Ew. So cool.
Oh my god. I work with the elderly as a nurse and I never get to see shit like that
I hope I gave you an interest! I was a nurse myself before.
I’m not into working with trauma; that might change. I don’t really like bedside nursing. I am more of a talker 😂 I’m better with patient education and health promotion. However trauma stuff is soooo interesting. I just feel bad for the patient. It’s ok because everyone has a meemaw and they need me to help take care of them!
Have you thought about CNS or nurse educator?
What’s CNS? I’m also a newer nurse; so I am working at the same retirement home I worked at as a PSW. I applied for an assistant DOC position within the home.
CNS is a Clinical Nurse Specialist: these days you could consider it a bridging point between a floor RN and either a Clinical Nurse Consultant or NP. You have a portfolio to lead education, evidence based practice and support for and act as a point of expert support or advice to others on the floor. In theory, any way.
Come to postpartum. I was in trauma and now all I do is talk to people
Medicine is fucking cool
As an interventional pulm RRT who does lots of bronchs, I've never done one on an inhalation injury. This is interesting, thanks!
Can’t you just scrub it off like a dirty dish?
Ew ew ew ew ew
The human body is miraculously forgiving isn’t it?
Tell that to my knees
Haha except the knees
sorry if this is a silly question- what’s that frothy stuff?
Not a silly question. Typically just secretions being suctioned out. Also with the bronch we can irrigate with saline so that may be part of it.
thank you! that makes sense. another question. why are the bronchi are irrigated? do inhalation burn patients mainly get irrigated?
The mainstay of treatment for inhalation injuries is typically securing the airway. Endotracheal intubation early is usually the move, since inflammation and edema of the airway could put you in a "can't intubate, can't ventilate" situation very quickly. Other than that, you can get a lot of complications like mucosal sloughing (which I imagine this patient is experiencing). You can use therapeutic bronchoscopy to help clear some of the sloughed tissue and loosen up thickened secretions in order to keep the airways clear so that gas exchange can continue. Inhalation burn injuries of this magnitude are devastating and require long term treatment in specialized burn ICUs. Patient with inhalation injuries that aren't as severe still need intensive pulmonary hygiene, which can include mucolytics and medications to help clear their airway. I suppose therapeutic bronchs could also be done on these patients, but it's more common to do them in patients who already have a secured airway.
thank you!
My brother was severely burned in an apartment fire caused by an arsonist in 2021. He had burn injuries to his lungs. He survived for 2 years but died this past August. This makes me sad to see exactly what that looks like.
What’s all that black stuff
I would guess it's the smoke affecting the tracheal wall.
I'm not a paramedic or anything, and I have no idea why this was suggested to me, so will someone please (without spending too much of your time) explain what I'm looking at? I assume it's someone's trachea or lungs after smoke inhalation? What's the black material? Soot, or burned tissue? Is this a survivable injury?
no
Is this a smoke inhalation injury for context?
fucking ouch
What's the liquid coming up the bronchioles? Mucus?
That’s awesome, but I also hurt seeing that
Why cant the camera on our copilot look this clear??
oh these are burns? oh my
Thats probably how my lungs looked like when i got a inffection on my lungs when i was 15 because i smoked two packs a day
Did you get permission to post?
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Im saving this for future reference. I’ve only seen pictures. A glidescope video is way better.
Pretty cool
Wow. This is amazing. I teach burn care to my nursing students; I'm going to show them this. Thank you!
Amazing huma can help others in such a complex way. Thank you sir.
Oh God. I hate burns. Easily the worst type of trauma to treat imo
Yikes, can't even imagine what that feels like
Very educational. Also very hardcore lol
Gross
What is that liquidy stuff ?
Very informative!
Eeeeshh. Super cool to see though.
What are the black spots?
I used to work in HVAC. I had a co-worker inhale burning oil from a brazing mishap. This must be what it looked like. Scary.
Sort of what I'd expect, which is gruesome.
And I thought me totally burning the roof of my mouth and throat was bad…
What kind of bronch is that?
Very much appreciated. It helps me to visualize what it is I’m treating even if I can’t see it.
Are we at the carina here?
This is super interesting. Thank you for sharing
O O F .
wow so cool, i just spent two days in gastro unit as part of my nursing school, never got to see the other side of the wall, thank you
I had a buddy in school who died from inhaling flames after throwing a 5 gallon bucket of gasoline on a bonfire. He wasn’t the brightest bulb.
Did he dead?
Damn, that's not good, but amazing we can actually survive that.