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Potentially life-threatening emergency
Smoke inhalation - Pulmonary
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Potentially life-threatening emergency

Smoke inhalation - Pulmonary

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Contributors: Susan Voci MD, Sumanth Rajagopal MD, William Bonnez MD
Other Resources UpToDate PubMed

Synopsis

The most common cause of death in fires is not thermal injury but rather the inhalation of noxious gases. Smoke is made of carbon dioxide, water vapor, carbon monoxide, fine particulate matter, hydrocarbons and other organics, and a variety of other substances. There may be many other toxic substances present in the smoke that increase when certain hazardous materials are burned, such as pressure-treated wood that may contain arsenic or chromate, insulation (including asbestos and fibrous materials), lead paint, particle board, asphalt (in roofing materials), used tires, rubber, plastics, vinyl materials, and foam padding (in mattresses and furniture).

Smoke inhalation can lead to many complications from irritation of the eyes and respiratory tract to acute and chronic lung disorders. The potential health problems will depend on what is being burned, concentrations of toxic substances in the smoke, the length of the exposure and individual susceptibility (which will vary depending on the health of the individual and any medical problems they may have). The elderly, those with preexisting heart or lung conditions, smokers, and young children may be affected more severely by smoke inhalation.

Carbon monoxide (CO) poisoning frequently results from smoke inhalation. The acute presentation includes headache, dizziness, or nausea. Infants may present with vomiting. Coma or seizures can occur in patients with prolonged exposure as well as altered mental status, retinal hemorrhages, and lactic acidosis as well as myonecrosis. MI may occur in the elderly, especially those with heart disease. Cherry-red skin color is associated with CO poisoning (2–3%).

Codes

ICD10CM:
T59.811A – Toxic effect of smoke, accidental, initial encounter

SNOMEDCT:
426936004 – Smoke inhalation injury

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

The diagnosis of smoke inhalation should be readily apparent given the nature of the injury. Be sure to elucidate all possible injuries and toxicities sustained.

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 10/14/2016
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Potentially life-threatening emergency
Smoke inhalation - Pulmonary
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Smoke inhalation : Cough, Dizziness, Headache, Nausea/vomiting, Loss of consciousness
Imaging Studies image of Smoke inhalation
Image from frontal chest x-ray in a child demonstrating bilateral, diffuse interstitial opacities, consistent with pulmonary edema. There is an endotracheal tube in the trachea, as well as an enteric tube extending into the duodenum.
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