Inhalation trauma due to toxins in smoke gas

In Germany, 372people died in fires in 2014 of which 80-90% succumbed from smoke gas. The most relevant inhalatory toxins are carbon dioxide, carbon monoxide (CO), cyanide and fast- and slow-acting irritant gases. Thermal injuries may also occur. After implementation of self-protection measures, the initial treatment of the patient includes stabilization of vitals and use of oxygen via a mask with a reservoir or intubation and ventilation with FiO(2)1.0, which must also be continued during (inner clinical) transport. About2/3 of all patients show signs of CO poisoning. Hyperbaric oxygen treatment may be consideredpossible indications are preceding syncope and/or coma, pregnancy, cardiac ischemia, seizures or severe metabolic acidosis. In case of CO poisoning, oxygen therapy is recommended until symptoms have resolved and carboxyhemoglobin (COHb) is normal (3%), usually for about 6h. Comatose patients who do not wakeup despite sufficient oxygenation may have aconcurrent cyanide poisoningadministration of hydroxocobalamine and possibly sodium thiosulfate (infused separately) should be considered. Since smoke also contains irritant gases, early application of (2)-sympathomimetics and possibly theophylline is recommended in case of bronchospasm. Administration of inhalative or intravenous glucocorticoids to prevent pulmonary edema is discussed controversially. All symptomatic patients should be hospitalized; in case of slow-acting irritant gases, preventive hospitalization can be considered. Upon presenting to the hospital, additional dermal or inhalatory thermal injuries must be considered. In case of glottis edema, an immediate intubation or tracheotomy may be required. Diagnostically, ablood gas analysis with measurement of COHb is considered essential. In case of suspected pulmonary edema, chest X-ray and in case of suspected thermal injuries diagnostic bronchoscopy should be performed. If the eyes are affected, rinsing must be performed immediately and in further course the patient should be referred to an ophthalmologist. Patients should be monitored for up to 48h.     «

In Germany, 372people died in fires in 2014 of which 80-90% succumbed from smoke gas. The most relevant inhalatory toxins are carbon dioxide, carbon monoxide (CO), cyanide and fast- and slow-acting irritant gases. Thermal injuries may also occur. After implementation of self-protection measures, the initial treatment of the patient includes stabilization of vitals and use of oxygen via a mask with a reservoir or intubation and ventilation with FiO(2)1.0, which must also be continued during (inne...     »