Injuries below the bronchi

Introduction Injury below the bronchi is one of the clinical manifestations of severe inhalation injury, including damage to the bronchus and muscle parenchyma.

Cause

Enclosed environment explosion or flame burn. The main cause of inhalation injury is thermal action, but at the same time, a large amount of unburned smog, carbon particles, and irritating chemicals are also inhaled, which also damages the respiratory tract and alveoli. Therefore, inhalation damage is a mixed damage of heat and chemicals.

Inhalation injury is related to the environment in which the injury occurs. It often occurs in an environment that is not ventilated or sealed, especially in an explosion. In this environment, the concentration of the hot flame is high, the temperature is high, and it is not easy to spread rapidly. The patient cannot immediately leave the fire; in addition, in a confined space, the combustion is incomplete, resulting in A large amount of carbon monoxide and other toxic gases make patients toxic and coma, and suffocate and die. When combined with explosive combustion, high temperature, high pressure, high flow rate of air and thick toxic gases can cause damage to the deep respiratory tract and lung parenchyma. In addition, the patient stands or rushes to shout, causing the heat to inhale, which is also one of the causes of injury.

an examination

Related inspection

Chest flat chest MRI lung and pleural percussion

Severe inhalation injury

Refers to the area below the bronchus, including damage to the bronchus and muscle parenchyma. Clinical manifestations of severe dyspnea immediately or within a few hours after injury, incision of tracheal deduction can not be alleviated; progressive hypoxia, lip cyanosis, increased heart rate, agitation, paralysis or coma; cough and phlegm, early pulmonary edema, Hemorrhagic foamy sputum; necrotic endometrial shedding, can cause atelectasis or suffocation. The auscultation of the lungs is low, rough, and can be heard and wheezing, followed by dry and wet rales. Patients with severe lung parenchymal injury may die of acute respiratory failure due to extensive alveolar damage and severe bronchospasm within a few hours after injury.

Diagnosis of inhalation injury: The diagnosis of inhalation injury is mainly based on the injury and clinical manifestations, combined with laboratory tests, X-rays and special examinations to determine whether there is inhalation injury, the location and extent of the injury.

1, medical history

The situation at the time of injury should be asked in detail. If there is a history of close spatial burns and a history of irritating or corrosive gases, the possibility of inhalation injury should be suspected.

2, clinical manifestations

The patient has a burn wound on the head and neck, especially the burn wound around the nose and mouth, the nose hair burnt, the oral and pharyngeal mucosa congestion, edema, and blisters; cough, cough, sputum with carbon particles; difficulty breathing, lack of Oxygen, irritability; hoarseness, tracheal endometrial shedding; pulmonary edema with hemoptysis foamy phlegm, lungs can smell low, rough or dry, wet rales. In the case of inhalation injury, dyspnea due to stenosis of the laryngotracheal edema becomes a high-pitched breath, and sometimes a sharp whistling sound is emitted. At this time, tracheal opening should be performed. Progressive dyspnea occurs in the early stage of severe inhalation injury, but in large-area burns, even if there is no inhalation injury, acute muscle dysfunction may occur in the early stage and dyspnea may occur.

3, X-ray inspection

In the past, X-rays were considered to have no diagnostic significance for inhalation injury. However, Wang Tianyi et al (1980) and Yang Zhiyi et al (1982) observed that the right anterior oblique X-ray was taken through animal experiments and clinical observations. The tracheal stenosis appeared 2 to 6 hours after injury, and the trachea showed spotted yin. The luminosity is reduced, the mucosa is irregular, and the characteristics of tracheal stenosis are shown early, which can be used as the X-ray change of the absorption. Pulmonary edema shows diffuse, slide-like shadows, inter-leaf images, hilar enlargement, linear or crescent-shaped images; central infiltrates or diffuse and dense infiltrates in the lung infection; sometimes A balloon-like transparency enhancement due to compensatory emphysema and a pneumothorax image due to alveolar rupture or emphysema-like vesicle rupture were seen.

4, special inspection

Fiberoptic bronchoscopy: fiberoptic bronchoscopy can directly observe the degree of damage of the throat, vocal cords, trachea, bronchial mucosa, and determine the site of injury. Because it can be taken, drained, and washed in the airway, it is a therapeutic tool. Dynamic observation by fiberoptic bronchoscopy can be used to understand the outcome of lesion evolution.

Differential diagnosis

Bronchial tree compression: common in bronchial damage, trachea, bronchus is the respiratory channel of the human body, trees are plants in nature, people associate the bronchus with the tree, because the shape of the trachea, bronchi and its branches is like a A tree with a lot of skill. However, the shape of the tree is inverted, the trunk is on the trachea, the branches are bronchi and the branches are below. In addition, the venturi tree is hollow, and its lumen is a passage for airflow. If the bronchial tree is damaged, it cannot pass through the fresh air inside the human body, and the carbon dioxide and the like are discharged from the body.

Bronchospasm: a disease commonly seen in the respiratory department, mainly diseases such as bronchitis. Smoking-induced asthma is mainly determined by various harmful components such as tar, nicotine and hydrogen cyanide contained in the smoke. Nicotine and the like can act on autonomic nerves, which can stimulate the vagus nerve and cause bronchospasm.

Bronchial smooth muscle spasm: also known as asthma. Bronchial asthma (referred to as asthma), the main pathological changes are bronchial smooth muscle spasm, is one of the common respiratory diseases in pediatrics. It is currently believed that bronchial asthma is a chronic airway inflammatory disease, and many cells play important roles in it, such as lymphocytes, eosinophils, mast cells, etc., accompanied by a significant increase in non-specific airway response. Airway hyperresponsiveness (BHR) is a multifactorial disease with major clinical features. Clinically, it mainly manifests as reversible wheezing and coughing episodes, chest tightness, and difficulty in breathing. These symptoms are often reversible, but they can also cause death. Therefore, the prevention and treatment of asthma should be taken seriously.

Small bronchial smooth muscle contracture: one of the major pathological changes in type I hypersensitivity diseases. Diseases associated with type I hypersensitivity reactions include atopic diseases [allergic rhinitis, allergic conjunctivitis, atopic dermatitis, and allergic asthma (exogenous and some urticaria, gastrointestinal food reactions, and systemic) Allergic reaction.

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