Out of all the possible complications of burns, the college examiners have been most interested in airway burns, and specifically in the various clinical features which alert you to the presence of such burns. Question 11 from the first paper of 2013, Question 13 from the second paper of 2006 and Question 11 from the second paper of 2000 are virtually identical: they all ask about airway burns, smoke inhalation injury and other forms of thermal damage to the upper respiratory tract. Question 23 from the second paper of 2017 is somewhat unique because it presented the candidates with a patient who has ARDS due to smoke inhalation, and who is ventilated with some profoundly stupid settings.
Mechanism |
Specific factors |
Clinical features | Management |
Thermal |
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Inflammatory |
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Inhaled agents |
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Anatomical location |
Mechanism |
Clinical features | Management |
Face |
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Oral cavity |
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Pharynx |
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Larynx |
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Trachea |
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Lungs |
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Question 23 from the second paper of 2017 offered the candidates a slightly singed miner, pulled out of some sort of underground conflagration. The question does not specifically ask about ARDS - rather, the candidates were asked as to why he might be so hypoxic. One of the main differentials would certainly be "inhalation injury resulting from exposure to pyrolysis and combustion atmospheres". The authors who have published the most helpful articles on this were Kimmel & Still (1999). They write mainly about the smoke inhalation experience of naval personnel, largely because military ships always seem to catch on fire and "because of the extraordinary difficulties associated with escape and avoidance of ship-board fire atmosphere". In contrast, Akgun & Gorguner (2010) report that acute lung injury due to inhalation of flaming gas seems to be epidemiologically more common among miners, because of the combination of inescapable confinement and limited fresh gas supply.
In summary:
Question 23 from the second paper of 2017 asks for several differentials for hypoxia in a miner pulled from an underground fire. His ABG result demonstrates a severe metabolic and respiratory acidosis. Specific elements which arouse concern in that setting are:
The differentials therefore are:
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Bartlett, Robert H., et al. "Acute management of the upper airway in facial burns and smoke inhalation." Archives of Surgery 111.7 (1976): 744-749.
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Bishop, Sophie, and Simon Maguire. "Anaesthesia and intensive care for major burns." Continuing Education in Anaesthesia, Critical Care & Pain 12.3 (2012): 118-122.
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Lund, Tjostolv, et al. "Upper airway sequelae in burn patients requiring endotracheal intubation or tracheostomy." Annals of surgery 201.3 (1985): 374.
Tredget, EDWARD E., et al. "The role of inhalation injury in burn trauma. A Canadian experience." Annals of surgery 212.6 (1990): 720.
Kimmel, Edgar C., and Kenneth R. Still. "Acute lung injury, acute respiratory distress syndrome and inhalation injury: an overview." Drug and chemical toxicology 22.1 (1999): 91-128.
Gorguner, Metin, and Metin Akgun. "Acute inhalation injury." The Eurasian journal of medicine 42.1 (2010): 28.