Toxic Gas & Smoke Inhalation

Meet the patient

A 34-year-old woman is pulled unconscious from an enclosed bedsit fire. There is soot around her mouth and nose and in her expectorations, and her voice is hoarse. On high-flow oxygen her pulse oximeter reads normal — which after a fire means little — and her plasma lactate is 11.4 mmol/L.^[4][6]

Two decisions dominate her first hour, and both are traps. The first is the airway: smoke inhalation injury declares in phases, and the early phase — the first 0 to 36 hours — is the phase of airway oedema, bronchorrhoea and bronchoconstriction, so you assess and protect the airway before it is lost. The second is cyanide: the European expert consensus lists an enclosed-space fire, any alteration in consciousness, cardiovascular changes (particularly inexplicable hypotension) and an elevated plasma lactate as the findings that suggest cyanide toxicity — and supports empiric hydroxocobalamin for fire-smoke victims without waiting for confirmation.^[2][3]

References22ShowHide

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