Toxic Exposures

Fires are extremely common after any natural disaster. Most deaths are caused by smoke inhalation. Numerous combustion products (carbon monoxide, hydrogen cyanide, ammonia, chlorine, phosgene, etc.) are released in a fire. The products released are often difficult to predict and depend on what type of material is burning. Smoke inhalation victims can have bronchopulmonary injury. Consider intubation in patients with soot surrounding their mouths and nares, voice changes, stridor, or wheezing, or ralpharyngeal swelling. Widespread pulmonary changes leading to acute respiratory distress syndrome (ARDS) can take up to 24 hours to become evident on chest radiography. A carboxyhemoglobin level and a lactate can help determine significant exposure to carbon monoxide or cyanide.