כוויות - האיגוד הישראלי לרפואה דחופה

כוויות - האיגוד הישראלי לרפואה דחופה

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  • PODCAST: Smoke Inhalation Injury
    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.

                                  • The post PODCAST: Smoke Inhalation Injury first appeared on האיגוד הישראלי לרפואה דחופה.

                                  11 min

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                                The Israel Association for Emergency Medicine