Question

1) Burns and smoke inhalation often occur together but may occur separately. When smoke is inhaled, toxic products of combustion injure airway tissues. Hot smoke usually burns only the pharynx because the incoming gas cools quickly. An exception is steam, which carries much more heat energy than smoke and thus can also burn the lower airways (below the glottis). Many toxic chemicals produced in routine house fires (e g, hydrogen chloride, phosgene, sulfur dioxide, toxic aldehydes, ammonia) injure lower airways chemically. What would be the indications for the respiratory therapist to engage in clinical interventions?

2)What is a Carboxyhemoglobin level, how it is obtained, and what is a normal limit?

Answer 1

protocols provide a means to provide quality respiratory services; ensure that resources are consumed in only the provision of necessary care; minimize complications and cost associated with variability; bridge the relationship between physicians, nurses, and respiratory therapists;

• Bronchodilators relax airway smooth muscle and are widely used in adults and children. The most frequently used are β-sympathomimetic agonists.
• Oral or intravenous steroids are the main treatment of acute asthma and also hasten recovery in acute COPD exacerbations. However, side-effects are seen with long-term treatment.
• Antibiotic treatment should be tailored to the specific infecting organism(s). This is particularly important in tuberculosis due to the increasing frequency of drug-resistant strains.
• The main methods of mechanical ventilatory support are: intermittent positive pressure ventilation, noninvasive ventilation and continuous positive airway pressure.
• Surgery is the treatment of choice for nonsmall cell lung cancer; surgical treatment is also used for selected patients with nonmalignant disease, including removal of benign tumours, lung volume reduction and pleural disease.

• Aids to smoking cessation

  Smokers should be strongly encouraged to stop; smoking cessation advice and support, together with various pharmaceutical products are available for those who wish to do so. Nicotine replacement allows some individuals to ease the effects of tobacco withdrawal.

• Bronchodilators

  Bronchodilators vary in both their mode and duration of action and they can be administered by various routes.All are aimed essentially at relaxing the smooth muscle of the airway wall and they are very widely used, both in adults and children, either as sole or adjunctive treatment for asthma and chronic obstructive pulmonary disease (COPD), and for other conditions characterised by diffuse airway narrowing, e.g. bronchiectasis.

• Corticosteroids

  Corticosteroids, such as prednisolone (given orally) or methyl prednisolone (given parenterally), are powerful anti-inflammatory agents used in a wide range of medical conditions. In respiratory practice, steroids are used most commonly by inhalation in the long-term treatment of asthma and COPD. Oral or intravenous steroids are the mainstay of treatment of acute asthma; in most cases, regular treatment for 5–10 days suffices and a similar approach has been shown to hasten recovery in acute exacerbations of COPD.

• Antibiotics

  For respiratory infections, antibiotics can be given either as a short course (5–10 days for acute infective exacerbations of COPD, for example) or on a longer-term basis, particularly for chronic bronchial infection (in cystic fibrosis (CF) or non-CF bronchiectasis, for instance).

answer 2-

Carboxyhemoglobin (COHb) is the product of the reaction between hemoglobin and carbon monoxide, and measurement of COHb is used in the diagnosis of carbon monoxide poisoning. Since carbon monoxide is a common pollutant present in cigarette smoke and car exhaust, it is difficult to be too dogmatic about what constitutes a normal COHb.

Best evidence quoted by the experts suggests that the upper limit of normal COHb should be set at between 2 and 3 % for non-smokers and between 7 and 9 % for non-smokers.