Recently in Acute Respiratory Distress Syndrome Category

December 5, 2013

Acute Respiratory Distress Syndrome (ARDS)

Also known as Adult Respiratory Distress Syndrome is a life threatening lung condition in which fluid accumulates in the lung leading to low levels of oxygen in the blood.

When a healthy person breathes, air will enter the nose and mouth passing through the trachea (windpipe) to reach the alveoli (air sacs) of the lungs. Oxygen will pass from the alveoli to small blood vessels surrounding the alveoli called the capillaries and from the capillaries to the bloodstream where it will be carried to different parts of the body. When the lung is injured from many causes including severe burns fluid and blood will leak from the capillaries into the alveoli, this will prevent air from entering the alveoli leading to decreased oxygen in the bloodstream and in turn decrease the oxygen supply to different organs which will affect their function. The lungs become inflamed, the inflammation will lead to scaring and fibrosis of the lungs causing the lungs to become stiff. This stiffness of the lung with fluid will make breathing very difficult for the patient.

Causes may include:

Symptoms and signs include:
  • Difficulty in breathing.
  • Increased respiratory rate (tachypnea).
  • Increased heart rate.
  • Fever.
  • Anxiety.
  • Wheezing herd with a stethoscope.
Diagnosis:

Investigations include arterial blood gas measurement, Chest X-ray, monitoring pulmonary capillary pressure by a pulmonary artery catheter introduced through a vein. Depending on the cause other investigations may include Complete blood count, liver function test, renal function test, CT scan and bronchoscopy.

Treatment:
Patients with ARDS are usually hospitalized and treated in the Intensive Care Unit, The goal of treatment is to provide breathing support and treat the cause of ARDS. This may involve:

  • Oxygen supplementation and the use of a mechanical ventilator (See mechanical ventilator part I, II).
  • Medications may be used in the form of antibiotics to treat infection, corticosteroids to reduce inflammation, pain medicine to reduce the pain, muscle relaxents to relax the muscles and decrease muscle spasms, antianxiety medications to decrease anxiety.
  • Intravenous fluid to prevent dehydration and provide nutrition.
Outlook:

Survival rate of patients with ARDS has improved; among factors that affect the outlook are the age of the patient, underlying cause of ARDS and any associated illness. Normal lung function is resumed in some patients after recovery. However others may experience breathing difficulties ranging from mild to severe. Patients who spend a long time on the ventilator and those with severe disease are more liable for persistent lung damage.

Possible complications:

  • Multiorgan system failure.
  • Ventilator associated lung infection (pneumonia).
  • Ventilator induced lung injury such as lung collapse and lung scarring (pulmonary fibrosis).

Support Groups
Many family members of patients with ARDS may suffer from severe stress. This stress can often be relieved by joining support groups where members can share common problems and experiences.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

October 20, 2011

New Information on True Causes of Death from Smoke Inhalation: Hydrogen Cyanide Poisoning

On October 6, 2011, the Fire Smoke Coalition launched the first Smoke Inhalation Treatment Database for use by EMTs, first responders and medical professionals throughout the world.

In the United States, residential fires are the third leading cause of fatal injury and the fifth most common cause of unintentional injury death, yet the majority of fire-related fatalities are NOT caused by severe burns--they are cause by smoke inhalation.

Despite the amount of fires in the U.S. decreasing each year, the amount of civilians dying in fires is actually increasing. For example, in 2009, 1,348,500 fires were attended by public fire departments, a decrease of 7.1 percent from the year before; however, 3,010 civilian fire deaths occurred, which is an increase of 9.3 percent.

In fire smoke, hydrogen cyanide can be up to 35 times more toxic than carbon monoxide, an underappreciated risk that can cause severe injury or death within minutes. In a review of major fires over a 19-year period, cyanide was found at toxic or lethal levels in the blood of approximately 33 percent to 87 percent of fatalities.

While many fire department medical directors and physicians have altered treatment protocols to consider cyanide as a deadly poison in smoke inhalation patients, thousands still have not. Until cyanide is presumed to be responsible along with carbon monoxide, especially in victims removed from closed-space structure fires, people will continue to die of what is actually a complicated illness. It cannot be assumed that carbon monoxide is the only poison requiring treatment, or that it is the sole cause of death.

The Coalition is requesting all medical providers and physicians to enter data following treatment to smoke inhalation victims. Information collected will be available to all medical professionals, day or night, and will hopefully provide insight into "new" treatment practices that include consideration of an antidote for cyanide poisoning associated with smoke inhalation--more than just hyperbaric chamber therapy that forces high amounts of oxygen into a patient to cleanse the lungs of carbon monoxide. There are only two FDA approved cyanide antidotes in the United States--the Cyanokit®, also known as Hydroxocobalamin, is one of them.

In April, the Congressional Fire Services Institute (CFSI) passed a resolution noting that there is mounting proof, obtained through atmospheric monitoring on fire grounds throughout the U.S., that hydrogen cyanide (HCN) is a predominant toxicant found in fire smoke. The resolution calls for educating the fire service about the dangers of smoke inhalation--including those of HCN--through support of a national education program, the development of HCN poisoning treatment protocols for all local and state emergency medical services (EMS), and efforts by the Centers for Disease Control and Prevention (CDC) to establish a national database of smoke inhalation injuries, medical complications and deaths linked to HCN.

If you or someone you know suffers a burn injury or a smoke inhalation injury, you should call Kramer & Pollack LLP in Mineola, NY so that the personal injury attorneys in that firm can determine whether another party has legal liability for injuries suffered, and if the injured party has a solid legal case.

June 9, 2011

A New Look at the Dangers of Smoke Inhalation


On May 19, the Fire Smoke Coalition sent out a press release saying that it "applauds the Congressional Fire Services Institute's (CFSI) National Advisory Council (NAC) passage of A Resolution to Address a New Epidemic: Smoke Inhalation at its April board meeting." CFSI is a leading non-partisan policy institute designed to educate members of Congress on the needs of our nation's fire and emergency services.

In its resolution, CFSI notes that there is mounting proof, obtained through atmospheric monitoring on fire grounds throughout the U.S., that hydrogen cyanide (HCN) is a predominant toxicant found in fire smoke. The resolution calls for educating the fire service about the dangers of smoke inhalation--including those of HCN--through support of a national education program, the development of HCN poisoning treatment protocols for all local and state emergency medical services (EMS), and efforts by the Centers for Disease Control and Prevention (CDC) to establish a national database of smoke inhalation injuries, medical complications and deaths linked to HCN.

To learn even more about the Fire Smoke Coalition and about HCN poisoning, click on this link.

"It's encouraging to see that both fire smoke and hydrogen cyanide poisoning are being recognized by CFSI for the serious and prevalent illnesses they are," said Rob Schnepp, assistant chief of Special Operations for the Alameda County (CA) Fire Department. "As we learn more about the dangers of fire smoke, and pass that information along to firefighters and civilians around the world, we are confident we can reduce the number of people injured and killed by smoke."

In the United States, residential fires are the third leading cause of fatal injury and the fifth most common cause of unintentional injury death, yet the majority of fire-related fatalities are not caused by burns, but by smoke inhalation. Despite the amount of fires in the U.S. decreasing each year, the amount of civilians dying in fires is actually increasing. For example, in 2009, 1,348,500 fires were attended by public fire departments, a decrease of 7.1 percent from the year before; however, 3,010 civilian fire deaths occurred, which is an increase of 9.3 percent.

In fire smoke, hydrogen cyanide can be up to 35 times more toxic than carbon monoxide, an underappreciated risk that can cause severe injury or death within minutes. In a review of major fires over a 19-year period, cyanide was found at toxic-to-lethal levels in the blood of approximately 33 percent to 87 percent of fatalities.

The Fire Smoke Coalition will begin working with various government agencies and medical associations in an effort to reduce the number of smoke inhalation deaths by elevating awareness surrounding hydrogen cyanide as the most deadly toxicant in fire smoke, which is treatable if detected.

"As a country, if we can accept that 30,654 human beings died during a 10-year period, we've become complacent about the illness," said Shawn Longerich, executive director of the Coalition. "That's unacceptable. This resolution raises the bar for all of us to do more and we can by embracing new medical treatment protocols that include consideration for hydrogen cyanide poisoning in fire smoke."