Smoke inhalation injury

Abstract

Pulmonary injury due to smoke inhalation is a significant cause of death in fire victims. Singed nasal hair and carbonaceous sputum are easily recognized warning signs, but other subtle clues should prompt thorough evaluation and aggressive treatment. Dr Lee-Chiong describes the basic mechanisms of injury and discusses how to assess and manage complications caused by smoke inhalation.

Central Diabetes insipidus following Carbon Monoxide Poisoning

“…However, to our knowledge, CO poisoning-induced CDI has not been previously reported in the medical literature, except a fatal case with DI after rescue from an apartment fire [4]. Although CO poisoning, hypoxia, and cardiac arrest were suggested to be the causes, the fire smoke containing a variable mixture of thermal loads, toxic gaseous vapors, and particular matter [5] might also have contributed to the development of CDI in the case.…”

Disaster preparedness: experience from a smoke inhalation mass casualty incident

“…Some authors, however, have cautioned that the potential threat of poisoning from byproducts of combustion [2,[5][6][7][8] in such patients should not be overlooked (see Table 2). This is a very real consideration in our case, as the materials combusted in the playground fire were mainly plastics, rubber, polyurethane foam and wood.…”

“…While bronchoscopy is considered the 'gold standard' for early evaluation of upper airway injury [2,3], there is no good way to evaluate pulmonary injury early, as these injuries evolve over time and parenchymal lung dysfunction can be minimal for 24-36 h [3]. Initial chest radiographs are often non-specific [2,3,13], such changes taking place over the next 1-2 days.…”

“…Initial chest radiographs are often non-specific [2,3,13], such changes taking place over the next 1-2 days. Our decision in performing the chest radiographs was to get a baseline for which later comparison could be made should repeat Xrays become necessary.…”

“…Patients were then assessed for symptoms and signs suggestive of possible inhalational injury, namely singed facial hair or eyebrows, singed nose hairs, stridor, wheezing, cough with carbonaceous sputum, hoarseness, carbon deposits and acute inflammatory changes in the oropharynx [1,2]. If any of these were present, such a patient would require a fibre-optic examination up to the level of the vocal cords, a chest radiograph and a carboxyhaemoglobin level with arterial blood gas analysis.…”