1/11. Long-term management of extensive tracheal stenosis due to formic acid chemical burn.We report on a 26-year-old woman who during early infancy (6 months) suffered from a chemical burn of the skin and upper airways due to spill of formic acid powder. Twenty years after the initial injury, she presented with dyspnea and stridor due to severe tracheal stenosis. Several interventional bronchoscopic manipulations were initiated: incision of the stenotic lesion with Nd:YAG laser and dilatation with a valvuloplasty balloon which enabled silicone stent placement which was subsequently kept in place for 3 years. Complications during the 4th year after stenting led to the successful replacement of this stent by two autoexpandable metallic stents covering the total length of the trachea from the subglottic area to the carina. In post-burn inhalation injuries, a complex inflammatory process may be active for many years after the initial insult. These injuries respond to prolonged tracheal stenting and a conservative approach is recommended.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
2/11. Endotracheal tube ignition by electrocautery during tracheostomy: case report with autopsy findings.This case of upper airway tract fire resulting from the use of electrocautery during elective tracheostomy has significance for surgeons, anesthetists, and forensic pathologists alike. The major autopsy findings are described and illustrated. Suggestions that may help to prevent or minimize the risk of fire in this context are reviewed.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
3/11. inhalation of liquid nitrogen vapor.A case of accidental inhalation of liquid nitrogen vapor is reported. The patient, a 29-year-old man, developed acute burns of his lips and oropharynx and presented with signs and symptoms of acute upper airway distress within an hour of the injury. The patient underwent emergency tracheostomy and was placed on intravenous dexamethasone and ampicillin. Large mucosal ulcers developed in the posterior hypopharynx and hard palate but the patient was discharged four days post operatively and had no permanent sequelae.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
4/11. The management of laryngotracheal stenosis in burned patients.Following burns of the upper respiratory tract, laryngotracheal stenosis is associated with considerable morbidity. This paper deals with the cumulative effect of various pathologic processes involved in burn trauma of the upper airway. Emphasis is placed on the extended use of endotracheal intubation and the avoidance of tracheostomy whenever possible. When laryngotracheal stenosis develops, it may be safely and successfully treated by prolonged stenting, as has been borne out by our experience with the T-shaped silicone tubes. Limited reconstructive procedures can be performed to facilitate proper placement of the stent. In our opinion, laryngotracheal resection and reconstruction are not the procedures of choice in burn cases. Our experience in following the preceding guidelines is described. Three illustrative cases serve to exemplify the difficulties and problems involved in the various stages of treatment and the results obtained. The patients are symptom-free 18 to 24 months following stenting, and all enjoy an adequate airway and good voice. There were no complications resulting from this treatment and we suggest that it is worthy of trial.- - - - - - - - - - ranking = 2keywords = upper (Clic here for more details about this article) |
5/11. Acute and chronic effects of ammonia burns on the respiratory tract.Exposure to anhydrous ammonia can result in substantial injury to the respiratory system, eyes, and integument. In this retrospective study, we present the acute and chronic respiratory manifestations in 12 patients exposed to anhydrous ammonia as a result of the same accident. survivors suffering significant ill effects are separated into two groups according to history and clinical course. One group of patients sustained exposure to high concentrations of ammonia over a short period of time. They manifested upper airway obstruction and required early intubation or tracheostomy. These patients recovered with few pulmonary sequelae and are presently in good pulmonary health. The second group of patients were exposed to lower concentrations of gas over a prolonged period of time and did not manifest upper airway obstruction. In this group of patients, however, significant long-term pulmonary sequelae are manifested.- - - - - - - - - - ranking = 2keywords = upper (Clic here for more details about this article) |
6/11. Fettler's disease with smoke inhalation: particles within the lung.In August 1985, a 72-year-old man died in the Manchester air disaster. Transmission electron microscopy of his lung tissue revealed not only inhaled smoke particles, but a large population of distinctive particles with different characteristics. These contain silicon and iron, as well as carbon and oxygen, and are thought to be related to his occupation as a fettler and to the extensive fibrosis seen on routine histology.- - - - - - - - - - ranking = 0.14673545025988keywords = chest (Clic here for more details about this article) |
7/11. Acute airway obstruction following facial scalding: differential diagnosis between a thermal and infective cause.A 16-month-old boy received a 6 per cent hot water scald to his face and chest. The child had been suffering from an upper respiratory tract infection for 10 days prior to the injury. However, as the child rapidly developed respiratory tract obstruction, a differential diagnosis between acute infective epiglottitis and thermal injury to the hypopharynx was required. In fact, the hot water had reached the epiglottis and the aryepiglottic folds causing significant damage, whilst sparing the tongue and mouth. The child was admitted to the intensive care unit, intubated and ventilated for 4 1/2 days. The external burns eventually healed spontaneously. This case report demonstrates the rare occurrence of a minor scalding injury resulting in significant obstruction to the upper airway. Of additional interest is the presence of pre-existing symptoms of an upper respiratory tract infection and the total absence of any signs of intraoral burning. These additional factors demonstrate the necessity for absolute vigilance in the management of any scald in the region of a child's mouth. intubation can be life saving and should be considered in any case of scalding associated with increasing respiratory distress.- - - - - - - - - - ranking = 3.1467354502599keywords = upper, chest (Clic here for more details about this article) |
8/11. Mucosal injuries of the upper aerodigestive tract after smoking crack or freebase cocaine.The introduction of "crack" and 'freebase" cocaine to the united states has resulted in an increased number of patients presenting to emergency rooms with cocaine-related burns of the upper aerodigestive tract. Because symptoms are nonspecific and histories often unreliable, the emergency room physician must keep a high index of suspicion for cocaine use when confronted with these types of patients. We present seven patients who had burns to the upper aerodigestive tract as a result of smoking crack or freebase cocaine. Two of seven patients underwent an emergency tracheotomy, probably because of delayed diagnosis and inadequate early medical intervention. This article reviews the history behind cocaine use, its different modes of administration, potential complications associated with smoking cocaine, diagnostic workup, and treatment options.- - - - - - - - - - ranking = 6keywords = upper (Clic here for more details about this article) |
9/11. Complications following butane inhalation and flash fire.Solvent inhalation is a well-documented form of drug abuse that can cause euphoria and hallucinations. Sudden death involving a volatile substance is most commonly caused by cardiac arrythmias, asphyxia, direct drug effects, and trauma. The victim in this paper suffered superficial partial thickness (12% total body surface area) burns from a flash fire that occurred when lighting a match after inhaling butane in an enclosed vehicle. The victim was admitted to the hospital for 2 days of observation but did not develop any respiratory symptoms under 2 days following her release. The victim died during her readmission, 9 days after the flash fire. Postmortem examination showed extensive epithelial injury from the upper airway and trachea to the terminal bronchioles, most likely due in part to both the initial inhalation injury and the resulting adult respiratory distress syndrome (ARDS) and staphylococcal infection. Many victims with superficial burn injuries may not seek medical attention owing to either embarrassment or fear of legal prosecution. Even those who do seek medical assistance may not reveal solvent abuse as the cause of their injuries. It is possible that delayed death may occur at home following volatile substance abuse but may remain unrecognized even with a thorough scene investigation.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
10/11. Successful utilization of ECMO to treat an adult burn patient with ARDS.We present an interesting case of the first adult reported in the united states to suffer from thermal burns, adult respiratory distress syndrome (ARDS) and to be treated with extracorporeal membrane oxygenation (ECMO) who survived. Our patient is a 26 year old male who sustained thermal burns (12% TBSA) to his face and anterior trunk and broncoscopically demonstrable inhalation injury. He was transported to our regional burn center for burn wound care and ventilatory support. The patient was treated with silver sulfadiazine 1% to his wounds which healed per primam. Because of low oxygen saturation he required increasing FIO2. The following parameters: FIO2= 1, PEEP = 17, minute ventilation of 15.1 1, peak airway pressure of 45 and mean of 27, along with chest x-rays corroborated the severity of ARDS. The patient failed volume control ventilation. A trial of pressure ventilation was attempted but the patient only reached O2 saturation in the low 80s. At this point, the decision was made to transfer the patient to a hospital capable of ECMO treatment. The patient was subsequently treated with veno venous ECMO. Six weeks later the patient was discharged from the hospital off all ventilatory support.- - - - - - - - - - ranking = 0.14673545025988keywords = chest (Clic here for more details about this article) |
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