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.