Smoke Inhalation Follow-up

  • Author: Keith A Lafferty, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Jun 30, 2010
 

Further Inpatient Care

Patients with smoke inhalation should be monitored for 4-6 hours in the ED. While there is no definite criteria for admission, the following patients should be strongly considered for hospitalization:

  • History of closed-space exposure for longer than 10 minutes
  • Carbonaceous sputum production
  • Arterial PO2 less than 60 mm Hg
  • Metabolic acidosis
  • HbCO levels above 15%
  • Arteriovenous oxygen difference (on 100% oxygen) greater than 100 mm Hg
  • Bronchospasm
  • Odynophagia
  • Central facial burns
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Further Outpatient Care

Although the literature is lacking regarding definite discharge criteria, patients whom otherwise do not meet admission criteria may be sent home after an observation period of 6 hours providing the following criteria are met:

  • Normal vital signs
  • Normal physical examination
  • Short smoke exposure
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Transfer

  • Treat patients with isolated smoke inhalation appropriately in any modern intensive care unit. However, transport patients with significant cutaneous burns (who otherwise meet criteria for transfer to a burn center) when stable.
  • Modern burn care has decreased the mortality rate in patients with thermal burns. A large retrospective chart review from 1972-1996 has shown that increasing burn size, older age, inhalation injury, and female sex increase the risk of death, while operative intervention and upper limb burns decrease the risk of death.[8]
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Deterrence/Prevention

A study shows that smoke detectors reduce the risk of death by about 60% in all subgroups of people.

  • This is in contrast to past data that suggest that these early warning devices may not be effective in populations that have difficulty responding to an alarm in a timely manner, such as children, older adults, persons with disabilities, or those impaired by alcohol or other drugs.
  • These new data clearly exemplify the point that all homes should have a working smoke detector in every room.
  • Although smoke detectors have been widely adopted by the public, and 93% of US households have one in place, it is estimated that 30-45% of these are not operational, usually due to nonreplacement or removal of batteries.
  • DiGuiseppi et al have shown that just merely giving out free smoke alarms in a deprived, multiethnic, urban community did not reduce injuries related to fire.[33] This was because few alarms had been installed or properly maintained.
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Complications

  • While the mortality rate for isolated smoke inhalation injury is lower than 10%, the addition of a cutaneous burn could almost quadruple this mortality rate.
  • Complications may include the following:
  • After the 1987 California forest fire disaster, local EDs saw a dramatic rise in asthmatic patients.
  • Another study of firefighters showed certain subgroups to have an exaggerated decline in postexposure FEV1 that was not predicted by age, smoking history, intensity of exposure, or the use of self-contained breathing apparatus. Some of these patients, who had no family history of reactive airway disease, went on to need long-term beta-agonist therapy. The many case series in the literature clarify that reactive airway disease, in a small sample of patients with smoke inhalation, is a real potential sequela.
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Patient Education

For excellent patient education resources, visit eMedicine's Lung and Airway Center, Procedures Center, and Poisoning Center. Also, see eMedicine's patient education articles Smoke Inhalation, Bronchoscopy, and Carbon Monoxide Poisoning.

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Contributor Information and Disclosures
Author

Keith A Lafferty, MD  Adjunct Assistant Professor of Emergency Medicine, Temple University School of Medicine; Medical Student Director, Department of Emergency Medicine, Gulf Coast Medical Center

Keith A Lafferty, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Harry J Goett, MD  Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Temple University Hospital

Harry J Goett, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel J Dire, MD, FACEP, FAAP, FAAEM  Clinical Professor, Department of Emergency Medicine, University of Texas Medical School at Houston; Clinical Professor, Department of Pediatrics, University of Texas Health Sciences Center San Antonio

Daniel J Dire, MD, FACEP, FAAP, FAAEM is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

James Steven Walker, DO, MS  Clinical Professor of Surgery, Department of Surgery, University of Oklahoma College of Medicine

James Steven Walker, DO, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and American Osteopathic Association

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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