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
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 hairsHoarseness, stridor (upper airway swelling)Carbonaceous sputum (lower airway edema)Systemic Symptoms:Headache, dizziness, nauseaSyncope, seizures, altered mental statusAirway 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 bloodTreatment: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.The post PODCAST: Smoke Inhalation Injury first appeared on האיגוד הישראלי לרפואה דחופה.
