Inhalation injury occurs due to the inhalation of smoke, toxic gases, or superheated air, leading to airway inflammation, respiratory distress, and systemic toxicity. It is commonly seen in burn victims, house fires, and industrial accidents. Early recognition and management are critical to prevent respiratory failure and carbon monoxide or cyanide poisoning. Pathophysiology Inhalation injuries can affect three key areas: Upper Airway (Supraglottic Injury): Thermal injury causes edema, leading to airway obstruction. Lower Airway (Infraglottic Injury): Chemical irritation from smoke causes bronchospasm, alveolar damage, and inflammation. Systemic Toxicity: Carbon monoxide (CO) and cyanide poisoning impair oxygen delivery and cellular respiration. Clinical…
Author: Dr Ben
Opioid Toxicity: Diagnosis and Management Introduction Opioid toxicity is a life-threatening condition resulting from excessive opioid exposure, leading to respiratory depression, altered mental status, and potential cardiovascular instability. Common opioids include morphine, heroin, oxycodone, fentanyl, codeine, tramadol, and methadone. This guide provides an in-depth look at diagnosis and management based on UK clinical guidelines. Pathophysiology Opioids act on mu (μ), kappa (κ), and delta (δ) receptors, primarily affecting the central nervous system (CNS) and respiratory centers in the brainstem. Toxicity results in: Respiratory depression (leading cause of mortality). Depressed consciousness (from mild drowsiness to coma). Miosis (pinpoint pupils) due to…
Carbon monoxide (CO) is a colorless, odorless, and tasteless gas produced by the incomplete combustion of carbon-containing fuels such as gas, wood, coal, and petrol. Exposure can occur from car exhausts, house fires, faulty gas heaters, and industrial solvents containing methylene chloride, which is metabolized to CO in the body. CO poisoning is a medical emergency due to its ability to bind haemoglobin (Hb), forming carboxyhaemoglobin (COHb), which reduces oxygen delivery to tissues, leading to severe hypoxia. Pathophysiology CO binds to haemoglobin with 200-250 times the affinity of oxygen, forming COHb, which: Reduces oxygen transport. Impairs oxygen release to tissues.…
Flail chest is a life-threatening thoracic injury that occurs when a segment of the rib cage becomes detached from the rest of the chest wall due to multiple rib fractures. This results in paradoxical chest movement, impairing respiratory mechanics and leading to hypoxia. Etiology and Causes Blunt chest trauma (e.g., motor vehicle accidents, falls, crush injuries) Severe impact sports injuries Penetrating trauma (less common but possible) Clinical Presentation Symptoms Severe chest pain and tenderness Dyspnea (difficulty breathing) Cyanosis (late sign of hypoxia) Shock (if associated with significant internal injuries) Signs Paradoxical chest movement (affected segment moves inward during inspiration and…
Prior to surgery, it is crucial to stop certain medications, foods, and drinks to reduce the risk of complications such as bleeding, delayed gastric emptying, and anesthetic interactions. This guide outlines best practices based on UK guidelines (NICE, Royal College of Anaesthetists, and British National Formulary – BNF). 1. Medications to Stop Before Surgery A. Anticoagulants & Antiplatelets Medication When to Stop Considerations/Alternatives Warfarin 5 days before Bridge with LMWH if high thrombotic risk DOACs (Apixaban, Rivaroxaban, Edoxaban, Dabigatran) 24-48 hours before (longer in renal impairment) Bridging not required in most cases Clopidogrel, Ticagrelor 5-7 days before Continue if recent…
Pneumothorax refers to the presence of air in the pleural space, leading to lung collapse. It can be classified as spontaneous (primary or secondary) or traumatic. Management depends on the type, size, and clinical stability of the patient. Types of Pneumothorax Primary Spontaneous Pneumothorax (PSP) – Occurs in healthy individuals, usually due to rupture of subpleural blebs. Secondary Spontaneous Pneumothorax (SSP) – Occurs in individuals with underlying lung disease (e.g., COPD, cystic fibrosis, tuberculosis). Traumatic Pneumothorax – Due to penetrating or blunt chest trauma. Iatrogenic Pneumothorax – Caused by medical procedures (e.g., central line insertion, lung biopsy, mechanical ventilation). Tension…
Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory condition characterized by airflow limitation that is not fully reversible. Acute exacerbation of COPD (AECOPD) is a sudden worsening of respiratory symptoms, requiring an immediate change in management. Exacerbations are associated with increased morbidity, hospitalizations, and mortality, making timely and effective treatment crucial. This article provides a detailed approach to managing AECOPD using NICE (National Institute for Health and Care Excellence), British Thoracic Society (BTS), and Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Definition of AECOPD An acute exacerbation of COPD is defined as a sustained worsening of baseline…