Smoke Inhalation
You can use a nasopharyngoscope to take a look at the airway. If the supraglottic area appears beefy red and sooty prepare for intubation soon but if it looks good that is reassuring - Shaun Mehta
image by: Quang Nguyen Vinh
HWN Suggests
Understanding Inhalation Injury
When assessing a burned or smoke exposed patient for inhalation injury, start by dividing the respiratory system into two regions: supraglottic and subglottic. In the emergency room or acutely following the burn injury or inhalation, the supraglottic airway should be assessed for current and sustained patency. The supraglottic airway will become edematous from uninhibited heat exchange at the level of the naso- and oropharynx, with the heat denaturing proteins and leading to histamine production. The smoke itself causes nitrous oxide production leading to vasodilation and edema in the upper airway. Classic physical exam findings concerning for supraglottic airway compromise that should prompt…
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Burn and Inhalation Injuries
While it is critical to anticipate impending airway compromise and consider securing an airway sooner rather than later, the systematic reviews suggests that 1/3 of burn patients are unnecessarily intubated in the ED. Signs such as singed nasal hairs and facial burns alone are not indications for intubation.
Articles of Interest
A Brief Review of Smoke Inhalation Injury
The pathophysiology and severity of inhalation injury varies with the aerosolized toxins particular to the circumstances of individual injuries.
A Case of Smoke Inhalation Injury
One of the earliest decisions to make in the management of patients with suspected smoke inhalation injuries is whether to secure the airway. In patient whom the airway is non-patent or there is an obstruction, the decision is easy to either attempt intubation via endotracheal tube or secure a surgical airway. The decision is less straight forward when the patient does not seem to be having any difficulties with ventilation and oxygenation.
Smoke Inhalation—Part 2
Failing to recognize or treat a patient for smoke inhalation can have significant consequences and lead to less-than-desirable outcomes.
Resources
Life in the Fastlane
Consider concomitant carbon monoxide and/or cyanide poisoning (cyanide is produced by the combustion of plastics, wools and various polymers).
Stat{Pearls
Hydrogen cyanide poisoning is difficult to determine in many cases. Testing results are not readily available. One antidote, hydroxocobalamin, may be given in patients with high suspicion of cyanide poisoning. It is nontoxic and renally excreted. Side effects do include redding of the skin and urine.
