Occupational medicine (Philadelphia, Pa.)
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Smoke inhalation may account for up to 75% of fire-related deaths and presents with a wide variety of complaints and findings. The authors examine the components of smoke to illustrate the patterns of smoke injury, provide useful guidelines on evaluation and management, survey current laboratory and diagnostic studies, and present their recommendations for treatment.
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The authors examine the acute and chronic effects of exposure to smoke among firefighters and look at mortality studies for the risk of death due to nonmalignant respiratory disease and lung cancer.
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In this comprehensive review, the authors describe various types of respirators and the major issues in their application to TB control, including the degree of protection they offer and cost. Recent recommendations regarding the use of respiratory protective devices also are discussed.
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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.