Smoke Inhalation Injury

• 3 Main Types of Injury

• Chemical

• Acrolein

• Wood or Petroleum

• Causes pulmonary edema, bronchorrhea, bronchospasm, tearing, conjunctivitis

• Hydrochloric Acid

• Plastics combustion

• Can be in air hours after fire extinguished

• Arrhythmias, delayed pulmonary edema, dyspnea and chest pain

• Nitrogen dioxide

• Automobiles 

• Severe bronchospasm, laryngospasm, pulmonary edema, interstitial lung disease

• Toluene Diisocyanate

• Carpet, isolation, seat cushions

• Severe bronchospasm

• Thermal

• Soot in nares and mouth

• Singed hair

• Black carbonaceous sputum

• Dyspnea, stridor, drooling, dysphonia, respiratory distress

• Systemic

• CO toxicity

• 30% fatality

• Formed from combustion of hydrocarbons

• Hypoxia

• Greater binding affinity to hemoglobin than O2

• ½ Life:

• Room Air -> 5hrs

• 100% -> O2 1hr

• HBO -> 24min

• Lactic Acidosis

• Inhibits oxidative phosphorylation

• Hypotension

• Induces NO2 and guanylate cyclase release causing vasodilation

• Delayed neurological sequelae

• Most commonly affects globus pallidus

• Intubate early if concern for airway edema

• PEEP improves O2 diffusion and decreases atelectasis

• HBO therapy

• Reduce risks of cognitive sequelae 6 and 12 months after exposure

• Indications

• Syncope, confusion/AMS, seizure, focal neuro deficit, pregnancy with CO level of >15% (fetal hgb will bind more CO), CO level >25%, Acute MI.