Smoke Inhalation - Dr. Kerns

• Most fire victims die from smoke inhalation rather than asphyxiation, thermal injury or burns

• If a patient has both burns and inhalation injuries, mortality increases 3-4x

• Soot acts as a carrier for other toxins which "piggy back" on soot into the pulmonary tree

• CO and CN are the most common toxins produced with breakdown of different materials.

Aggressive treatment of cyanide

• Often die from CNS effects - CN is a CNS stimulant
• Soot and AMS from inhalation ---- think cyanide
  

• Lactate over 10 --- think CN!
  Doesn't mean you exclude CN if lactate is under 10
  

• Treat:
  Hydroxycobalamin - Adults get 5gm over 15 min; Kids get 70mg/kg up to 5gm
  Thiosulfate - cheap with few significant adverse effects
  

When to pursue HBO for carbon monoxide
Think of this in pts with LOC, cerebellar symptoms, persistent HA after 4 hrs of supplemental oxygen

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