Occupational medicine (Philadelphia, Pa.)
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Exposure to asphyxiant gases is a ubiquitous feature of the fire environment, particularly in structural (or closed-space) fires. The clinician evaluating the smoke-inhalation patient must keep in mind the manifold actions of systemic toxicants upon an individual whose pulmonary gas exchange may be compromised and whose circulatory and metabolic status may be stressed by burns, hypo- or hypervolemia, and intercurrent disease. Also to be considered is the likelihood of exposure to multiple toxicants whose physiologic effects may be synergistic and whose therapeutic demands may be conflicting. As newer therapeutic regimens and rapid laboratory tests become available, the clinician should be prepared to evaluate their strengths and limitations for the complex task of evaluating and treating smoke-inhalation patients.
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Smoke-inhalation injury may range from lethal effects of entrapment in a burning closed structure to a minor exacerbation of preexisting asthma or bronchitis following a transient whiff of smoke. This article reviews the pathophysiology of smoke-inhalation injury and the clinical pattern of respiratory tract injury. Various diagnostic tools are used to determine the presence and severity of respiratory injury in order to guide management decisions. Despite improved understanding of the pathogenesis of smoke-inhalation injury, there is no proven, specific treatment which offers superior outcomes, and management focuses on the nonspecific effects of smoke inhalation on respiratory function, general support of the patient, and avoidance of iatrogenic problems.