Acute Respiratory Distress Syndrome (ARDS) is a relatively delayed complication of smoke inhalation injury caused by chemical fumes inducing an inflammatory response in the lung tissue especially the small air sacs known as alveoli where critical gas exchange occurs. Another potential complication is swelling of the upper airway from both heat and chemical damage and can become profound enough to obstruct breathing. The onset of airway swelling can be relatively delayed making it difficult to intubate later on thus endotracheal intubation should be considered early in certain patients. Other possible complications include pneumonia, vocal cord damage and/or dysfunction, and tracheal stenosis (usually delayed). Mechanism
Inhalation of chemical toxins produced by combusting materials can cause damage to tissues of both the upper (above larynx) and lower respiratory tract (below larynx). Damage to lower airways, air sacs, and lung tissue is due to an inflammatory cascade in response to the noxious chemicals which causes a variety of downstream effects such as increased secretions and exudative material thus clogging the airways and/or air sacs, collapse of air sacs (atelectasis), vascular permeability leading to pulmonary edema (fluid in the lungs), bronchoconstriction, activation of the coagulation cascade, and impaired function of the mucociliary escalator.Inhalation of hot fumes can cause thermal damage to tissues usually limited to the upper respiratory tract (above larynx).
While corneal thickness can be a valuable indicator of how the cornea is changing over time, it is affected by multiple factors and is not adequate itself as a screening tool to diagnose Fuchs dystrophy. Treatment
Non-surgical treatments of FECD may be used to treat symptoms of early disease. Medical management includes topical hypertonic saline, the use of a hairdryer to dehydrate the precorneal tear film, and therapeutic soft contact lenses. Hypertonic saline draws water out of the cornea through osmosis. When using a hairdryer, the patient is instructed to hold it at an arms length or directed across the face in a cold setting, to dry out the epithelial blisters. This can be done two or three times a day. Scleral lenses can improve vision when it is affected by irregularities on the surface of the cornea, but may stress the corneal endothelium. Corneal transplantation is the definitive treatment for FECD. The most common types of surgery for FECD are Descemets stripping automated endothelial keratoplasty (DSAEK) and Descemets membrane endothelial keratoplasty (DMEK), which account for over half of corneal transplants in the United States. Injection of cultured endothelial cells is under investigation and in a series of 11 patients in Japan with bullous keratopathy, was able to clear corneal edema. Epidemiology
Few studies have examined the prevalence of FECD on a large scale.