الفهرس 
EPIDEMIOLOGYOnly 14 pages are availabe for public view
Abstract
Acute damage to the respiratory system caused by inhalation of toxic agents is usually a sporadic event that occurs as a consequence of an accidental chemical release in a workplace or a smoke inhalation from a residential fire. When chemical disasters or fire cause widespread exposures, however, acute inhalation injury can be a common occurrence (Miller, 2003).
Toxic, inhaled substances differ in physical and chemical qualities; this affects their toxicity and site of action. Gases are formless liquids that can expand to occupy an available space. Fumes form when a solid, which has been volatilized by evaporation or vaporization, condenses in cool air. Dusts are suspensions of solid particles in a gaseous media. Smoke results from the incomplete combustion of carbon-containing material including oil and coal (Winder, 2004).
Most often, exposures are to mixtures of many diverse chemicals, which may be present as gases and particles, thus forming aerosols, as is the case with burning wood, plastics or other materials (Winder, 2004).
At trace levels, the reactive Toxic inhalational gases are perceived as pungent and irritating, and induce sneezing, coughing, mucus secretion, upper airway inflammation, and tearing. At higher levels, these sensory neuron–mediated sensations and responses progress to incapacitating pain, uncontrollable coughing, profuse lacrimation, and resistance to airflow by bronchospasm, mucus hypersecretion, and upper and lower airway inflammation (pneumonitis). These responses neutralize, hinder, and expel toxic materials, limiting damage to the delicate alveolar sacs. However, continued exposures can lead to exaggerated responses that compromise respiratory function (Merrel and Mayo, 2004).
The diagnosis of inhalation injury is a somewhat subjective decision based largely on a history of exposure. Physical examination may include findings such as visible injury to the respiratory tract, airway edema or evidence of pulmonary parenchymal damage and dysfunction. These findings may be confirmed by diagnostic studies including fiberoptic bronchoscopy (Tomashefski, 2000).
Measures for the management: (1) Remove the patient as quickly as possible as a vital first aid measure. (2) Establish a clear airway to minimise the work of breathing. (3) Cardiorespiratory resuscitation should be undertaken as appropriate and careful replacement of the intravascular volume is required to maintain haemodynamic stability.
Patients with various forms of lung injury are now being treated with ventilator strategies involving: (1) Non-invasive ventilation. (2) Invasive ventilation. Ventilator strategies must support oxygenation and ventilation and reflect the experience of the clinical team managing the patient (Cancio, 2005).