Core EM - Emergency Medicine Podcast

Episode 207: Smoke Inhalation Injury

Listen Later

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.

                                • Read More
                                ...more
                                View all episodesView all episodes
                                Download on the App Store
                                Core EM - Emergency Medicine PodcastBy Core EM
                                • 4.5
                                • 4.5
                                • 4.5
                                • 4.5
                                • 4.5

                                4.5

                                233 ratings

                                More shows like Core EM - Emergency Medicine Podcast

                                View all
                                EMCrit FOAM Feed by Scott D. Weingart, MD FCCM

                                EMCrit FOAM Feed

                                1,867 Listeners

                                Emergency Medicine Cases by Dr. Anton Helman

                                Emergency Medicine Cases

                                530 Listeners

                                FOAMcast - An Emergency Medicine Podcast by FOAMcast

                                FOAMcast - An Emergency Medicine Podcast

                                279 Listeners

                                JAMA Clinical Reviews by JAMA Network

                                JAMA Clinical Reviews

                                485 Listeners

                                The Resus Room by Simon Laing, Rob Fenwick & James Yates

                                The Resus Room

                                104 Listeners

                                EM Clerkship by Zack Olson, MD and Michael Estephan, MD

                                EM Clerkship

                                800 Listeners

                                The Curbsiders Internal Medicine Podcast by The Curbsiders Internal Medicine Podcast

                                The Curbsiders Internal Medicine Podcast

                                3,321 Listeners

                                Emergency Medical Minute by Emergency Medical Minute

                                Emergency Medical Minute

                                262 Listeners

                                Core IM | Internal Medicine Podcast by Core IM Team

                                Core IM | Internal Medicine Podcast

                                1,091 Listeners

                                The Internet Book of Critical Care Podcast by Adam Thomas & Josh Farkas

                                The Internet Book of Critical Care Podcast

                                700 Listeners

                                The Clinical Problem Solvers by The Clinical Problem Solvers

                                The Clinical Problem Solvers

                                508 Listeners

                                Run the List by Walker Redd, Emily Gutowski, Navin Kumar, Joyce Zhou, Blake Smith

                                Run the List

                                242 Listeners

                                Critical Care Scenarios by Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM

                                Critical Care Scenarios

                                245 Listeners

                                The Curious Clinicians by The Curious Clinicians

                                The Curious Clinicians

                                362 Listeners

                                Critical Care Time by Critical Care Time Podcast

                                Critical Care Time

                                214 Listeners