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2015 ; 7
(ä): 31-7
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Assessing inhalation injury in the emergency room
#MMPMID27147888
Tanizaki S
Open Access Emerg Med
2015[]; 7
(ä): 31-7
PMID27147888
show ga
Respiratory tract injuries caused by inhalation of smoke or chemical products are
related to significant morbidity and mortality. While many strategies have been
built up to manage cutaneous burn injuries, few logical diagnostic strategies for
patients with inhalation injuries exist and almost all treatment is supportive.
The goals of initial management are to ensure that the airway allows adequate
oxygenation and ventilation and to avoid ventilator-induced lung injury and
substances that may complicate subsequent care. Intubation should be considered
if any of the following signs exist: respiratory distress, stridor,
hypoventilation, use of accessory respiratory muscles, blistering or edema of the
oropharynx, or deep burns to the face or neck. Any patients suspected to have
inhalation injuries should receive a high concentration of supplemental oxygen to
quickly reverse hypoxia and to displace carbon monoxide from protein binding
sites. Management of carbon monoxide and cyanide exposure in smoke inhalation
patients remains controversial. Absolute indications for hyperbaric oxygen
therapy do not exist because there is a low correlation between carboxyhemoglobin
levels and the severity of the clinical state. A cyanide antidote should be
administered when cyanide poisoning is clinically suspected. Although an ideal
approach for respiratory support of patients with inhalation injuries do not
exist, it is important that they are supported using techniques that do not
further exacerbate respiratory failure. A well-organized strategy for patients
with inhalation injury is critical to reduce morbidity and mortality.