Acute inhalation injury

https://doi.org/10.1016/S0733-8627(03)00011-7Get rights and content

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Classification schemes

Numerous classification schemes have been developed as a way to organize the enormous numbers of possible inhaled toxicants. Most reviews of acute toxic inhalations are based on the agent's mechanism of toxicity, such as whether it is a pulmonary irritant or systemic toxicant [1], [2]. For this review, the authors have chosen to organize the toxicants based on the location or source of the exposure, because this is often how patients (especially multi-casualty patients) actually present to the

Relevant respiratory anatomy

Several elements of respiratory anatomy contribute to protection of the airways and lungs from inhaled toxicants and particulates. In the upper airway, particulates in the 5–10-μm range are trapped through air turbulence on the mucosal surface of the nasal turbinates. In the conducting airways, ciliated and mucus-secreting epithelium constitutes the mucociliary escalator, which moves inhaled particles up proximally. Within the trachea and bronchi, this mucociliary escalator can move inhaled

Clinical assessment

Symptoms of acute inhalation injury can be delayed in onset. The clinical setting of facial burns, inflamed nares, sputum production, and wheezing in victims of fires or explosions in enclosed spaces, or altered mental status at the scene affecting the ability to escape, can all be conditions preceding the onset of symptoms of acute inhalation injury. Cough is likely the first symptom. Occasionally cough may reflect cough-variant asthma or irritant-associated vocal cord dysfunction caused by

Smoke inhalation

The single most likely cause of acute inhalation injury in emergency medicine practice is smoke inhalation from residential or commercial structure fires. In addition, smoke inhalation emergencies can present as multi-casualty incidents. Smoke inhalation is the leading cause of death from structure fires, particularly from fire in multistory structures. Smoke inhalation also adds to mortality from cutaneous thermal burns. Mortality rates from smoke inhalation are approximately 5%–8% [6].

Occupation and industry

Exposure to toxic inhalations can occur in almost any occupation (Box 4). For purposes of this review, the authors discuss a select group of industries. The reader is referred to the textbook by Sullivan and Krieger for a more thorough discussion of toxic exposures that can occur in many other industries [22]. Regardless of the industry or occupation, however, any case of syncope in an industry in which gases or vapors are present needs a thorough workplace investigation by health professionals

Chemical and biologic weapons

Unlike most occupational inhalational exposures, chemical warfare agents often need specific immediate treatment in addition to the usual supportive care. Suspicion for such agents are obviously higher in times of war, criminal acts, or acts of terrorism.

Summary

The lungs can be an efficient means for the absorption of inhaled toxicants, resulting in airway and pulmonary injury or systemic toxicity. Although a few specific antidotes exist for inhaled toxicants, the syndrome of acute inhalation injury and clinical therapeutics are linked by common pathways of pathophysiology. Understanding the mechanisms of inhalation injury and occupation- or situation-specific toxicants can simplify the decision-making process for the out-of-hospital emergency

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