Episode 207: Smoke Inhalation Injury скачать в хорошем качестве

Episode 207: Smoke Inhalation Injury

(https://coreem.net/podcast/episode-20...) We discuss the injuries sustained from smoke inhalation. Hosts: Sarah Fetterolf, MD Brian Gilberti, MD https://media.blubrry.com/coreem/cont... Download (https://media.blubrry.com/coreem/cont...) Leave a Comment (https://coreem.net/podcast/episode-20...) Tags: Environmental (https://coreem.net/tag/environmental/) , Toxicology (https://coreem.net/tag/toxicology/) Show Notes 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. Read More (https://coreem.net/podcast/episode-20...)