Inhalation Injury

Hx: A male in his 20’s is working when he mixes lime away and bleach in a bottle. He then breathes some of the resultant gas and becomes short of breath, develops an intractable cough, and his co-workers call EMS. He is given a single albuterol nebulizer treatment on the way to the hospital along with supplemental oxygen by non-rebreather mask. He arrives tachypneic with a cough that is preventing him from speaking in full sentences. PMHX: none SocHx: occasional alcohol, no tobacco or drugs Exam:  Vitals: BP 160/90, HR 120, RR 25, sat 100% on NRB mask, temp 98.6 F (37 C) HEENT: No trauma, watery eyes, no eyelid edema, normal eye movements and pupil reaction. Pharynx clear. Clear rhinorrhea. Neck: Supple Resp: Bilateral expiratory wheezes in between frequent coughing, non-productive. no SQ crepitance, equal breath sounds. In moderately severe respiratory distress. Cardiovascular: Tachycardia, regular, pulses symmetrical bilaterally. Abdomen: Soft, non-tender. Extremities: Normal pulses, warm Differential:  Chlorine gas inhalation Bronchospasm Doubt pneumonia ED Course:  Multiple nebulizer treatments with improvement in cough and distress. He becomes comfortable with clear breath sounds He maintains a slight hypoxia after 3 hours of observation (88% saturation on room air) with improvement in remainder […] Continue Reading

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