Smoke inhalation injury: Difference between revisions
 
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*Carbonaceous sputum
*Carbonaceous sputum
*Singed nasal or facial hair
*Singed nasal or facial hair
*Dyspnea, stridor, drooling, dysphonia, respiratory distress
*[[Dyspnea]], [[stridor]], drooling, [[dysphonia]], [[respiratory distress]]


===Chemical injury===
===Chemical injury===
''Varies depending on substance burned in fire''
''Varies depending on substance burned in fire''
*Acrolein: found in wood and petroleum
*Acrolein: found in wood and petroleum
**Pulmonary edema, bronchorrhea, bronchospasm, VQ mismatch which can cause hypoxemia
**[[Pulmonary edema]], bronchorrhea, bronchospasm, VQ mismatch which can cause [[hypoxemia]]
**Tearing, conjunctivitis
**Tearing, [[conjunctivitis]]
*Hydrochloric acid: product of polyvinyl chloride (structural component of high-rise buildings, plastics) combustion.  
*[[Hydrochloric acid]]: product of polyvinyl chloride (structural component of high-rise buildings, plastics) combustion.  
**Can persist in air up to an hour after fire extinguished
**Can persist in air up to an hour after fire extinguished
**PVCs and other arrythmias
**PVCs and other [[arrhythmias]]
**Delayed onset (2-12 hours) pulmonary edema
**Delayed onset (2-12 hours) [[pulmonary edema]]
**Dypsnea, chest pain
**[[Dyspnea]], [[chest pain]]
*Tuolene diisocyanate: seat cushions, carpet, insulation
*Tuolene diisocyanate: seat cushions, carpet, insulation
**Severe bronchospasm
**Severe bronchospasm
*Nitrogen dioxide: fires involving automobiles, agrecultural waste
*Nitrogen dioxide: fires involving automobiles, agrecultural waste
**Uncommon but brief exposure can be lethal
**Uncommon but brief exposure can be lethal
**Severe bronchospasm, laryngospasm, pulmonary edema
**Severe bronchospasm, laryngospasm, [[pulmonary edema]]
**Later: interstitial lung disease
**Later: [[interstitial lung disease]]


===Systemic chemical injury===
===Systemic chemical injury===
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==Differential Diagnosis==
==Differential Diagnosis==
{{Burn DDX}}
{{Burn DDX}}
{{Inhalation exposure}}
{{Toxic gas exposure DDX}}


==Evaluation==
==Evaluation==
*Assess ABCs, [[burns]] resuscitation
*Assess ABCs, [[burns]] resuscitation
*ABG or VBG, carboxyhemoglobin
*[[ABG]] or VBG, carboxyhemoglobin
*[[ECG]], monitor on telemetry
*[[ECG]], monitor on telemetry
*Chest x-ray
*[[Chest x-ray]]
*Low threshhold for direct or video laryngoscopy, fiberoptic airway eval
*Low threshold for direct or video [[laryngoscopy]], fiberoptic airway eval


==Management==
==Management==
'''AIRWAY'''
'''AIRWAY'''
*Intubate if:
*[[Intubate]] if:
**Respiratory distress, respiratory depression, or altered mental status
**Respiratory distress, respiratory depression, or altered mental status
**Progressive hoarseness
**Progressive hoarseness
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**Full thickness burns to face or perioral region
**Full thickness burns to face or perioral region
**Circumferential neck burns
**Circumferential neck burns
**Major burns over 40-60% of body surface area
**Major burns over 40-60% of [[Estimating body surface area|body surface area]]
''Remember, the intubation will only get more difficult as edema worsens!''
''Remember, the intubation will only get more difficult as edema worsens!''
*Bronchodilators if evidence of bronchospasm
*[[Bronchodilators]] if evidence of bronchospasm
*See [[Carbon monoxide toxicity]]
*See [[Carbon monoxide toxicity]]
*See [[Cyanide toxicity]]
*See [[Cyanide toxicity]]


==Disposition==
==Disposition==
* Respiratory distress or airway compromise will need admission
* Observe for 1-4 hours if no signs or symptoms of inhalation injury develop or if all resolved within 1 hour consider discharging patient home with instructions for return for re-evaluation next day or sooner if pulmonary and/or airway symptoms develop


==See Also==
==See Also==
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**[[Carbon monoxide toxicity]]
**[[Carbon monoxide toxicity]]
**[[Cyanide toxicity]]
**[[Cyanide toxicity]]
*[[Intubation]]


==External Links==
==External Links==
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[[Category:Trauma]]
[[Category:Trauma]]
[[Category:Pulmonary]]

Latest revision as of 20:35, 8 November 2023

Background

  • Main cause of mortality in fire-related death
  • Associated with closed-space fires, especially when patient has decreased mental status (e.g. substance use, head injury)
  • Thermal injury:
    • Due to inhaling superheated gases in an enclosed space
    • Direct thermal trauma and associated edema usually limited to upper airway, but lower respiratory tract may be injured if steam inhaled
  • Chemical injury:
    • Direct toxicity to airways and lung parenchyma from noxious chemicals combusted

Clinical Features

Thermal injury

Chemical injury

Varies depending on substance burned in fire

Systemic chemical injury

Differential Diagnosis

Burns

Inhalation injury

Unintentional
Terrorism

Toxic gas exposure

Evaluation

  • Assess ABCs, burns resuscitation
  • ABG or VBG, carboxyhemoglobin
  • ECG, monitor on telemetry
  • Chest x-ray
  • Low threshold for direct or video laryngoscopy, fiberoptic airway eval

Management

AIRWAY

  • Intubate if:
    • Respiratory distress, respiratory depression, or altered mental status
    • Progressive hoarseness
    • Supraglottic or laryngeal edema/inflammation on bronchoscopy or NPL
    • Full thickness burns to face or perioral region
    • Circumferential neck burns
    • Major burns over 40-60% of body surface area

Remember, the intubation will only get more difficult as edema worsens!

Disposition

  • Respiratory distress or airway compromise will need admission
  • Observe for 1-4 hours if no signs or symptoms of inhalation injury develop or if all resolved within 1 hour consider discharging patient home with instructions for return for re-evaluation next day or sooner if pulmonary and/or airway symptoms develop

See Also

External Links

References

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