Ver el código de «Inhalation injury»

==Background==
* Inhalational injury a concern with history of being trapped in enclosed space for some time with toxic gases / fumes 

==Clinical Features==
===General===
* Initial signs/symptoms - [[cough]], [[wheezing]], [[dyspnea]], irritated mucous members (runny eyes/nose), [[chest pain]], [[hypoxia]]
* Specific features dependent on type of exposure
===Inert Gases===
* Inert gases (carbon dioxide, fuel gases) displace air and oxygen producing asphyxia
* Present with severe [[hypoxia]]
===Irritant Gases===
* Irritant gases ([[ammonia toxicity|ammonia]], formaldehyde, [[chlorine gas|chlorine]], nitrogen dioxide) when dissolved in water lining respiratory tract produce a [[chemical burns|chemical burn]] and inflammatory response
* More soluble the gas produces more upper airway burns/irritation symptoms
* Less soluble gases produce more pulmonary injury and [[respiratory distress]]

===Systemic Toxins===
* Includes [[carbon monoxide]], hydrogen [[cyanide]], [[hydrogen sulfide]]
* Interfere with delivery of oxygen for use in cellular energy production
* Liver, kidney, brain, lung and other organ damage
===Allergic===
* Inhaled gases, particles, aerosols
* Produce bronchospasms and edema similar to [[asthma]]
===[[Smoke inhalation injury|Smoke Inhalation / Thermal]]===
* Most fatalities from burn injuries are attributed to smoke inhalation
* Soot in posterior pharynx, singed nasal hair
* Hyperacute - severe [[wheezing]], [[bronchoconstriction]], significant [[hypoxemia]]
* Acute [[pulmonary edema]] - onset at 48-72 hours post injury in a previously asymptomatic patient
* Broncho[[pneumonia]] often at 10 days post-injury

==Differential Diagnosis==
{{Inhalation exposure}}
{{Burn DDX}}
{{Toxic gas exposure DDX}}

==Evaluation==
*Look for evidence of exposure
** Estimated time of exposure
** Open or enclosed space
** Associated events such as fire, blast, etc.?
** Is the exposure known?
** Material on patient? Does patient smell of chemical?
: Examples - smoke inhalation from burning building, leak of a solvent, chemical fumes
* Physical examination with focus on airway and pulmonary system
* Observe for evidence of airway compromise or respiratory distress
* [[Chest x-ray]], pulse oximetry, [[ABG|arterial blood gas]]
* Consider [[carbon monoxide toxicity|carboxyhemoglobin]] and/or [[cyanide]] level if any suspicion based on history

==Management==
===General===
* Separate patient from fumes/toxic agent 
* Decontaminate if not done on scene
* Secure airway if necessary and ventilate, observe for respiratory distress and airway compromise
* [[Oxygen]] at 6-12 liters per minute via mask

===Inert Gases===
* Remove victim from the gas
* Fresh air or oxygen
* Observe for sequelae  from [[hypoxia]] ([[myocardial infarction]], cerebral injury)

===Allergic===
* Aerosolized [[bronchodilators]]
* [[Corticosteroids]] in patients with history of reactive airway disease

===Smoke Inhalation / Thermals===
* Ensure adequate oxygenation, ventilation, pulmonary toilet and [[IVF|fluid resuscitation]]

==Disposition==
* Respiratory distress or airway compromise will need admission
* Observe for 1-4 hours if no signs or symptoms of inhalation injury develop or if all resolved within 1 hour consider discharging patient home with instructions for return for re-evaluation next day or sooner if pulmonary and/or airway symptoms develop

==See Also==
*[[Smoke inhalation injury]]
*[[Inhalant abuse]]
*[[Burns]]

==External Links==

==References==
<references/>

[[Category:Environmental]] [[Category:Toxicology]]