Podcasts · Core EM - Emergency Medicine Podcast
Episode 207: Smoke Inhalation Injury
· Episode 207
Episode Episode 207: Smoke Inhalation Injury
We discuss the injuries sustained from smoke inhalation.
Hosts: Sarah Fetterolf, MD Brian Gilberti, MD
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Smoke_Inhalation.mp3
Download Leave a Comment Tags: Environmental, Toxicology
Show Notes Table of Contents
00:37 – Overview of Smoke Inhalation Injury
00:55 – Three Key Pathophysiologic Processes
01:41 – Physical Exam Findings to Watch For
02:12 – Airway Management and Early Intervention
03:23 – Carbon Monoxide Toxicity
04:24 – Workup and Initial Treatment of CO Poisoning
06:14 – Cyanide Toxicity
07:19 – Treatment Options for Cyanide Poisoning
09:12 – Take-Home Points and Clinical Pearls
Physiological Effects of Smoke Inhalation:
• Thermal Injury:
• Direct upper airway damage from heated air or steam. • Leads to swelling, inflammation, and possible airway obstruction.
• Chemical Irritation:
• Causes bronchospasm, mucus plugging, and inflammation in the lower airways. • Increases capillary permeability, potentially causing pulmonary edema.
• Systemic Toxicity:
• Primarily involves carbon monoxide and cyanide poisoning.
Clinical Signs and Symptoms:
• Physical Exam:
• Facial burns, singed nasal hairs • Hoarseness, stridor (upper airway swelling) • Carbonaceous sputum (lower airway edema)
• Systemic Symptoms:
• Headache, dizziness, nausea • Syncope, seizures, altered mental status
Airway Management Considerations:
• Not every patient requires immediate intubation. • Intubation should be performed early if airway compromise is suspected, as swelling can rapidly progress. • Close airway monitoring recommended for all patients.
Carbon Monoxide Poisoning:
• Common cause of death post-smoke inhalation (50–75% of fire-related injuries). • Hemoglobin affinity 250 times greater for CO than oxygen, impairing tissue oxygenation. • Diagnosis:
• Carboxyhemoglobin level via VBG (ensure proper lab ordering). • Pulse oximetry unreliable; falsely high readings.
• Treatment:
• Immediate high-flow oxygen administration. • Consider hyperbaric oxygen therapy for severe cases to reduce delayed neurocognitive sequelae.
Cyanide Poisoning:
• Blocks cytochrome oxidase in electron transport chain, halting aerobic ATP production. • Patients present critically ill; notable features include:
• Elevated lactate levels (>8–10 mmol/L) • Arterialization of venous blood
• Treatment:
• First-line therapy: hydroxocobalamin (Cyanokit) binds cyanide forming vitamin B12 for renal excretion. • Alternative: Cyanide antidote kit (amyl nitrite, sodium nitrite, sodium thiosulfate); induces methemoglobinemia and requires monitoring. • Important note: hydroxocobalamin turns blood and urine bright red; draw labs beforehand.
Key Takeaways:
• Assess for airway compromise and signs of inhalation injury early. • Maintain a high index of suspicion for CO and cyanide poisoning in smoke inhalation victims. • Immediate, aggressive oxygen therapy and early antidote administration can significantly impact outcomes.
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Links in the notes 5
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