Respiratory Care for Burn Patients

Burn victims with second degree burns or third degree burns have challenges beyond just the insult to their skin.  They often need respiratory care for smoke or steam inhalation. Even purely steam burn victims can have
compromise of the airway due to hot gases.  Failing to tackle the lung problems or airway problems can be life-threatening, even if the actual part of the burned skin is not extensive.

The job of the respiratory therapist in the care of burns is a big one.  They may be responsible for obtaining arterial blood gases to check for oxygenation of the blood.  They may be involved in early intubation of the burn victim
to prevent loss of the airway from swelling of the tissues.  They may also help the doctor with bronchoscopies to check for airway damage deeper in the lungs, and will perform ventilator management and airway maintenance
until the patient’s respiratory functions improve.

Some Techniques a Respiratory Therapist might do

The respiratory therapist will be engaged in helping the burn victim perform “therapeutic coughing”.  This is important in clearing the airway of mucus and excess fibrin casts.  If the patient cannot cough well, there can be
collapse of the tiny alveoli that help to exchange oxygen and carbon dioxide and resultant pneumonia.  The bronchi can be obstructed by mucus that can’t be cleared from the airways.

The respiratory therapist can ask the patient to take successively stronger coughs to build up the cough reflex.  He or she can place the index and middle fingers directly in the sternal notch below the patient’s neck.  Massaging
this area will help trigger a cough in cases where the patient is just coming out of a coma or anesthesia.

The respiratory therapist can also simulate a cough in a patient who has a ventilation tube by pumping up the cuff around the tube, squeezing a quick breath into the lungs with an Ambu bag, holding the breath in for a few
seconds and allowing for a slow exhale that can clear the lungs and airway of phlegm.
The patient can be positioned in such a way as to let gravity and percussion on the chest wall to bring up mucus and debris from the lungs.  There are 12 different positions that can be utilized in what is called “postural
drainage”.    Vibrating the chest while the patient is exhaling can loosen secretions as well.

Just getting the patient up and walking can stimulate coughing and airway release of secretions.  If all of the above things aren’t satisfactory and especially if the patient can’t move or cough on his own, the airway may need to
be suctioned every two hours so that secretions can be eliminated from the body.  If the patient does not have an endotracheal tube in place, he or she can be suctioned via the nose, in which a tube is passed from the nose
down through the vocal cords so as to suction out mucus.
If all else fails to remove secretions from the body, a fiberoptic bronchoscope can be passed down the trachea so that secretions can be visualized and cleared.  By using a thin bronchoscope, even smaller airways can be
suctioned effectively.

Respiratory Medications

The respiratory therapist can make use of bronchodilating medications, which can lessen spasm of the airways.  Patients with pre-existing asthma or other airway disease will be especially affected and helped by these
medications.  For example, nebulizing treatments with a medication like albuterol can very quickly open up narrowed airways.  Other medications are available that can do the same thing, such as metaproterenol or racemic
A unique way of clearing mucus is to use a strong saline solution and put droplets of it into the trachea and bronchi.   It draws mucus out of the tissues so it can then be suctioned more readily out of the lungs.  Acetylcholine can
also be used as an aerosol.  It contains chemical properties that break up stubborn mucus and help bring it up and out of the body.

If Mechanical Ventilation is Necessary

Sometimes, the patient needs to be in a coma due to extreme pain or because of a respiratory insult.  The respiratory therapist is an important part of the ventilator process.  The ventilator can completely control the
respirations or can assist the patient in taking his own breaths.  The ventilator can be set to give the patient a fast respiratory rate with smaller breaths each time in order to reduce the damage to the lungs that can come from
putting too much pressure on them.   Sometimes the ventilator can be set to provide positive air pressure even when the lungs have let out the breath.  It is a process called PEEP and it keeps the airways from collapsing.

In Summary

Many burn victims with second and third degree burns have lung injuries as well.  For this reason, the respiratory therapist is important in the management of the patient’s airway as he or she recovers from their injury.

A serious burn is a catastrophe. Anyone who has a serious burn thru the negligence of another should contact an experienced catastrophic injury lawyer.
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