March 2021: ​The Toxicity of Fire Smoke

A 54-year-old man was brought to the ED unresponsive by paramedics after his neighbors called 911 because they smelled smoke in his apartment. The patient was found unconscious in his living room, and a fire was burning in an adjoining room.His initial vital signs were a blood pressure of 115/80 mm Hg, a heart rate of 120 bpm, a respiratory rate of 30 bpm, an SPO2 of 94% on a nonrebreather, and a temperature of 98.9° F. The patient was unresponsive to verbal and physical stimuli but had spontaneous respirations. His nose and mouth were filled with soot, his lungs had trace wheezes, and his skin appeared flushed.What toxins should be considered in a patient with signs of smoke inhalation?•    Carbon monoxide (CO): asphyxiant and chemical toxicity effects•    Hydrogen cyanide (HCN): generated during burning of synthetic building and furnishing materials (polyurethane, melamine, nylon, etc.) and natural materials (wool, silk)•    Irritant smoke products (nitrogen oxides, hydrogen chloride, hydrogen bromide)•    Carbon dioxide: asphyxiantWhat information can help determine toxic smoke exposure?•    Was it an indoor or outdoor fire? Patients are unlikely to develop toxic levels of carbon monoxide unless they are in an enclosed structure. Hydrogen cyanide is generated from the burning of synthetic building material and therefore unlikely to be the cause of injury in an outdoor fire.•...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs