Assistance of inhalation injury victims caused by fire in confined spaces: what we learned from the tragedy at Santa Maria
| Autor: | Luiz Marcelo Sá Malbouisson, César Biselli Ferreira, Leandro Costa Miranda, Filipe Matheus Cadamuro, Viviane Rossi Figueiredo, Estevão Bassi, Maria Cecília Toledo Damasceno, Paulo Fernando Guimarães Morando Marzocchi Tierno |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Male medicine.medical_specialty Injury control Critical Care Accident prevention Poison control Case Report Intoxication/etiology Critical Care and Intensive Care Medicine Fires Disasters Carbon Monoxide Poisoning Confined Spaces Urban fires medicine Humans Case reports business.industry General Medicine Middle Aged Smoke Inhalation Injury Respiration Artificial Surgery Oxygen Respiratory insufficiency/etiology Inhalation injury business Respiratory Insufficiency Humanities Brazil |
| Zdroj: | Revista Brasileira de Terapia Intensiva |
| ISSN: | 1982-4335 |
| Popis: | On January 2013, a disaster at Santa Maria (RS) due to a fire in a confined space caused 242 deaths, most of them by inhalation injury. On November 2013, four individuals required intensive care following smoke inhalation from a fire at the Memorial da América Latina in São Paulo (SP). The present article reports the clinical progression and management of disaster victims presenting with inhalation injury. Patients ERL and OC exhibited early respiratory failure, bronchial aspiration of carbonaceous material, and carbon monoxide poisoning. Ventilation support was performed with 100% oxygen, the aspirated material was removed by bronchoscopy, and cyanide poisoning was empirically treated with sodium nitrite and sodium thiosulfate. Patient RP initially exhibited cough and retrosternal burning and subsequently progressed to respiratory failure due to upper airway swelling and early-onset pulmonary infection, which were treated with protective ventilation and antimicrobial agents. This patient was extubated following improvement of edema on bronchoscopy. Patient MA, an asthmatic, exhibited carbon monoxide poisoning and bronchospasm and was treated with normobaric hyperoxia, bronchodilators, and corticosteroids. The length of stay in the intensive care unit varied from four to 10 days, and all four patients exhibited satisfactory functional recovery. To conclude, inhalation injury has a preponderant role in fires in confined spaces. Invasive ventilation should not be delayed in cases with significant airway swelling. Hyperoxia should be induced early as a therapeutic means against carbon monoxide poisoning, in addition to empiric pharmacological treatment in suspected cases of cyanide poisoning. |
| Databáze: | OpenAIRE |
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