Inhalation Injury Medication

  • Author: Denise Serebrisky, MD; Chief Editor: Michael R Bye, MD   more...
 
Updated: Mar 22, 2012
 

Medical Gases

Class Summary

Oxygen is used for any suspected significant inhalation injury. Treat with high concentrations of humidified oxygen en route to the hospital.

Humidified oxygen

 

Use of high oxygen flow rates and a nonrebreathing-type face mask with a tight seal facilitates delivery of high levels of supplemental oxygen, which helps reverse the oxygenation defect created by ventilation-perfusion mismatch. Inhaled oxygen also helps in the displacement of CO from hemoglobin, decreasing the half-life of carboxyhemoglobin from 4-6 h in room air to 40-60 min in 100% FiO2.

Hyperbaric oxygen therapy (HBO)

 

This therapy also displaces CO from intracellular stores and may improve mitochondrial function. HBO requires special facilities that are not available at all centers, resulting in a delay in treatment while the patient is transported to facility with HBO. Hyperbaric therapy should be considered in those patients who have high carboxyhemoglobin levels >40%, who are unconsciousness, have other neurologic findings, or have severe metabolic acidosis (ph < 7.1). Benefit of treating patients 12 h after CO exposure remains unproven.

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Bronchodilators

Class Summary

These agents relieve reversible bronchospasm by relaxing smooth muscles of the bronchi. Increased resistance from airway edema and reflex bronchoconstriction from irritation of airway receptors contribute to airway obstruction.

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Nebulized albuterol (Proventil, Ventolin)

 

Relaxes bronchial smooth muscle by action on beta2-receptors with little effect on cardiac muscle contractility.

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Epinephrine racemic (MicroNefrin, AsthmaNefrin, Racepinephrine)

 

Alleviates airway edema and reflex bronchospasm. Although it has not been directly studied, inhaled racemic epinephrine can theoretically provide relief from both airway edema and reflex bronchospasm in this setting.

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Terbutaline (Brethine)

 

Used for severe bronchoconstriction, especially in patients with underlying reactive airways disease. Acts directly on beta2-receptors to relax bronchial smooth muscle, relieving bronchospasm and reducing airway resistance.

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Epinephrine (Adrenaline, EpiPen)

 

Used for severe bronchoconstriction, especially in patients with underlying reactive airways disease. Alpha-agonist effects that include increased peripheral vascular resistance, reversed peripheral vasodilatation, systemic hypotension, and vascular permeability. Beta-agonist effects of epinephrine include bronchodilatation, chronotropic cardiac activity, and positive inotropic effects.

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Contributor Information and Disclosures
Author

Denise Serebrisky, MD  Assistant Professor, Department of Pediatrics, Albert Einstein College of Medicine; Director, Division of Pulmonary Medicine, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center; Director, Jacobi Asthma and Allergy Center for Children

Denise Serebrisky, MD is a member of the following medical societies: American Thoracic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Emily B Nazarian, MD  MD, Assistant Professor of Pediatrics, Fellowship Director, Pediatric Critical Care, Golisano Children's Hospital at Strong

Emily B Nazarian, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Heidi Connolly, MD  Associate Professor of Pediatrics and Psychiatry, University of Rochester School of Medicine and Dentistry; Director, Pediatric Sleep Medicine Services, Strong Sleep Disorders Center

Heidi Connolly, MD is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Girish D Sharma, MD  Professor of Pediatrics, Rush Medical College; Senior Attending, Department of Pediatrics, Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush University Medical Center

Girish D Sharma, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Charles Callahan, DO  Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center

Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, and Christian Medical & Dental Society

Disclosure: Nothing to disclose.

Mary E Cataletto, MD  Director of Children's Sleep Services, Winthrop Sleep Disorders Center; Professor of Clinical Pediatrics, State University of New York at Stony Brook

Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians

Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Michael R Bye, MD  Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

References

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Table. Inhalants[2, 3]
TypeInhalantSourceInjury/Mechanism
Irritant gasesAmmoniaFertilizer, refrigerant, manufacturing of dyes, plastics, nylonUpper airway epithelial damage
ChlorineBleaching agent, sewage and water disinfectant, cleansing productsLower airway epithelial damage
Sulfur dioxideCombustion of coal, oil, cooking fuel, smeltingUpper airway epithelial damage
Nitrogen dioxideCombustion of diesel, welding, manufacturing of dyes, lacquers, wall paperTerminal airway epithelial damage
AsphyxiantsCarbon monoxide*Combustion of weeds, coal, gas, heatersCompetes for oxygen sites on hemoglobin, myoglobin, heme-containing intracellular proteins
Hydrogen cyanide†Burning of polyurethane, nitrocellulose (silk, nylon, wool)Tissue asphyxiation by inhibiting intracellular cytochrome oxidase activity, inhibits ATP production, leads to cellular anoxia
Hydrogen sulfide‡Sewage treatment facility, volcanic gases, coal mines, natural hot springsSimilar to cyanide, tissue asphyxiant by inhibition of cytochrome oxidase, leads to disruption of electron transport chain, results in anaerobic metabolism
Systemic toxinsHydrocarbonsInhalant abuse (toluene, benzene, Freon); aerosols; glue; gasoline; nail polish remover; typewriter correction fluid; ingestion of petroleum solvents, kerosene, liquid polishes CNS narcosis, anesthetic stats, diffuse GI symptoms, peripheral neuropathy with weakness, coma, sudden death, chemical pneumonitis, CNS abnormalities, GI irritation, cardiomyopathy, renal toxicity
OrganophosphatesInsecticides, nerve gasesBlocks acetylcholinesterase, cholinergic crisis with increased acetylcholine
Metal fumesMetal oxides of zinc, copper, magnesium, jewelry makingFlulike symptoms, fever, myalgia, weakness
* Major component of smoke



† Smells like almonds, component of smoke from fires



‡ Smells like rotten eggs



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