Where There Is Smoke… Inhalation Injuries, Carbon Monoxide, and Cyanide Poisoning

2008 ◽  
Vol 30 (2) ◽  
pp. 180-187 ◽  
Author(s):  
Michael Sahjian ◽  
Michael A. Frakes
Keyword(s):  
Carbon Monoxide ◽  
Smoke Inhalation ◽  
Cyanide Poisoning

scholarly journals Is There An Ideal Prehospital Drug Treatment For Acute Cyanide Poisoning?

2015 ◽  
Vol 12 (3) ◽  
Author(s):  
Craig B Barraclough
Keyword(s):  
Carbon Monoxide ◽  
Drug Treatment ◽  
Sodium Nitrite ◽  
Keyword Search ◽  
Haemodynamic Effects ◽  
Smoke Inhalation ◽  
Cyanide Poisoning ◽  
Sodium Thiosulphate ◽  
Negative Effects ◽  
Amyl Nitrite

IntroductionCyanide, due to its toxicity and prevalence in a variety of industries, is a suitable agent for terrorists or disaffected persons to use as a weapon of terror. New Zealand’s National Poisons Centre lists five cyanide antidotes. This review aimed to identify whether there is an ideal pre-hospital drug treatment for acute cyanide poisoning.MethodsLiterature less than 10 years old was selected after a keyword search. The articles were reviewed for specific positive and negative properties of each antidote.ResultsThirty-nine articles were reviewed of which four were excluded. Results varied, with hydroxocobalamin scoring highly on effectiveness, with limited negative effects. It also demonstrated positive haemodynamic effects, suitability in cases involving trauma, carbon monoxide (CO), smoke inhalation casualties and was safe for pre-hospital use. Sodium nitrite, followed by dicobalt edetate had the next highest scores for efficacy. However, both scored negatively for their effects on blood, causing hypotension and toxicity, and they are unsuitable for trauma, CO or smoke inhalation casualties. Sodium thiosulphate, with a moderate level of efficiency, remained most effective when co-administered with other antidotes. 4-dimethylaminophenol and amyl nitrite rated the lowest, with negative effects similar to sodium nitrite. Adrenaline was tested as an antidote in one study where two novel antidotes both demonstrated promising results.ConclusionHydroxocobalamin had the highest success rate and its safety profile make it the most suitable pre-hospital drug treatment for acute cyanide poisoning.

scholarly journals A case of cyanide poisoning complicated with carbon monoxide poisoning caused by smoke inhalation

2014 ◽  
Vol 25 (10) ◽  
pp. 797-803
Author(s):  
Yasumasa Iwasaki ◽  
Akira Narame ◽  
Kazunobu Une ◽  
Kohei Ota ◽  
Yoshiko Kida ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
Smoke Inhalation ◽  
Cyanide Poisoning

scholarly journals Smoke inhalation injury during enclosed-space fires: an update

2013 ◽  
Vol 39 (3) ◽  
pp. 373-381 ◽  
Author(s):  
Ana Carolina Pecanha Antonio ◽  
Priscylla Souza Castro ◽  
Luiz Octavio Freire
Keyword(s):  
Carbon Monoxide ◽  
Carbon Monoxide Poisoning ◽  
Fiberoptic Bronchoscopy ◽  
Orotracheal Intubation ◽  
Inhalation Injury ◽  
Smoke Inhalation ◽  
Cyanide Poisoning ◽  
Smoke Inhalation Injury ◽  
Acute Airway Obstruction ◽  
Enclosed Space

In view of the tragic fire at a nightclub in the city of Santa Maria, Brazil, which culminated in the sudden death of 232 young people, we decided to review the literature regarding smoke inhalation injury caused by enclosed-space fires, which can be divided into direct thermal damage, carbon monoxide poisoning, and cyanide poisoning. Such injuries often call for immediate orotracheal intubation, either due to acute airway obstruction or due to a reduced level of consciousness. The diagnosis and the severity of the thermal injury can be determined by fiberoptic bronchoscopy. The levels of gases and gas by-products in the bloodstream should be assessed as rapidly as possible, even while still at the scene of the incident. First responders can also treat carbon monoxide poisoning, with immediate administration of oxygen at 100%, as well as cyanide poisoning, with oxygen therapy and hydroxocobalamin injection

An experimental study of the influences of tobacco smoke on fertility and reproduction

1999 ◽  
Vol 18 (4) ◽  
pp. 272-278 ◽  
Author(s):  
Ewa Florek ◽  
Andrzej Marszalek
Keyword(s):  
Experimental Study ◽  
Carbon Monoxide ◽  
Tobacco Smoke ◽  
Female Rats ◽  
Dose Effect ◽  
Smoke Inhalation ◽  
Initial Number ◽  
Cigarette Brand ◽  
Duration Of Pregnancy ◽  
Parent Generation

1 The aim of this study was to evaluate the toxicological influence of tobacco smoke on fertility and reproduction of Wistar female rats. The influence of tobacco smoke from the Polish ‘Popularne’ cigarette brand was studied. The experiment was conducted on three generations of animals, each generation having two litters. The initial number of animals of the parent generation FO was 192 (128 females and 64 males). Animals were passively exposed to tobacco smoke in three different concentrations based on the content of carbon monoxide (500, 1000 and 1500 mg of CO per cubic meter of air). Animals were exposed to tobacco smoke for 6 h a day, 5 days a week, during 11 weeks. 2 The analysis of indices of mating and fertility revealed the decrease in those indices with animals exposed to tobacco smoke. We also observed an increased number of mothers breading among animals exposed to tobacco smoke. In animals exposed to tobacco smoke, the dose-effect or dose-response dependencies for mating, fertility and delivery indices were found. There was no influence of tobacco smoke on the duration of pregnancy. 3 Tobacco smoke inhalation caused increased levels of carboxyhaemoglobin. 4 Tobacco smoke did not change the duration of pregnancy in rats.

Clinical and Neuropathological Findings of Acute Carbon Monoxide Toxicity in Chihuahuas Following Smoke Inhalation

2010 ◽  
Vol 46 (4) ◽  
pp. 259-264 ◽  
Author(s):  
Marc Kent ◽  
Kate E. Creevy ◽  
Alexander deLahunta
Keyword(s):  
Carbon Monoxide ◽  
Cerebral Cortex ◽  
Case Report ◽  
Substantia Nigra ◽  
Supportive Care ◽  
Caudate Nucleus ◽  
Supplemental Oxygen ◽  
Smoke Inhalation ◽  
Dorsal Thalamus ◽  
Initial Improvement

Three adult Chihuahuas were presented for evaluation after smoke inhalation during a house fire. All three dogs received supportive care and supplemental oxygen. After initial improvement, the dogs developed seizures. Despite anticonvulsant therapy and supportive care, the dogs died. The brains of two dogs were examined. Lesions were identified that were compatible with acute carbon monoxide (CO) toxicity. Lesions were confined to the caudate nucleus, the globus pallidus, and the substantia nigra bilaterally, as well as the cerebellum, cerebral cortex, and dorsal thalamus. This case report describes the clinicopathological sequelae in acute CO toxicity.

Intraosseous administration of hydroxocobalamin after enclosed structure fire cardiac arrest

2021 ◽  
Vol 14 (3) ◽  
pp. e239523
Author(s):  
Joshua Mastenbrook ◽  
Rachel Zamihovsky ◽  
Nathan Brunken ◽  
Thomas Olsen
Keyword(s):  
Cardiac Arrest ◽  
Circulatory System ◽  
Neurological Status ◽  
Human Case ◽  
Spontaneous Circulation ◽  
Smoke Inhalation ◽  
Cyanide Poisoning ◽  
Hospital Arrival ◽  
Marrow Cavity ◽  
Developed World

Smoke inhalation is the most common cause of acute cyanide poisoning in the developed world. Hydroxocobalamin is an antidote for cyanide poisoning. There is little published about human intraosseous antidote administration. We present a case of intraosseous hydroxocobalamin administration in an adult smoke inhalation victim, found in cardiac arrest inside her burning manufactured home. Return of spontaneous circulation was achieved after 20 min of cardiopulmonary resuscitation. Five grams of hydroxocobalamin were subsequently given intraosseously. On hospital arrival, patient was found to have a respiratory-metabolic acidosis. She had red-coloured urine without haematuria, a known sequela of hydroxocobalamin administration. Patient’s neurological status deteriorated, and she died 4 days after admission. This case highlights that intraosseously administered hydroxocobalamin seems to adequately flow into the marrow cavity and enter the circulatory system despite the non-compressible glass antidote vial. This appears to be only the second reported human case of intraosseous hydroxocobalamin administration.

scholarly journals Characteristics of patients with carbon monoxide poisoning due to smoke inhalation and pre-hospital factors related to intensive care unit admission of these patients: a nationwide observational study

2021 ◽  
Keyword(s):  
Intensive Care Unit ◽  
Carbon Monoxide ◽  
Intensive Care ◽  
Observational Study ◽  
Multiple Logistic Regression Analysis ◽  
Smoke Inhalation ◽  
Co Poisoning ◽  
Icu Admission ◽  
Hospital Factors ◽  
O2 Supply

This study aimed to investigate the pre-hospital clinical status of patients with carbon monoxide (CO) poisoning by smoke inhalation and the pre-hospital factors associated with these patients’ admission to the intensive care unit (ICU). In this observational study from January 2016 to December 2018, the National Fire Agency’s first aid activity log on patients with smoke inhalation was matched with National Emergency Department Information System’s patient data with CO poisoning and further analyzed retrospectively. Multiple logistic regression analysis was conducted to identify the relevant pre-hospital associative factors for the decision to admit a patient with CO poisoning to the ICU. Of the 4422 patients with CO poisoning included in the study, 358 (8.09%) were admitted to the ICU. In such patients transported by pre-hospital emergency medical services, age (odds ratio [OR], 1.020; 95% confidence interval [CI], 1.010–1.029), verbal (OR, 3.564; 95% CI, 2.390–5.315), pain (OR, 4.011; 95%CI, 2.661–6.045), unconsciousness (OR, 5.728; 95% CI, 2.708–12.113), SBP (OR, 0.979; 95% CI, 0.969–0.989), HR (OR, 1.011; 95% CI, 1.004–1.018), SpO2 (OR, 0.965; 95% CI, 0.946–0.985), O2 supply (OR, 1.725; 95% CI, 1.143–2.603), use of nasal prongs (OR, 0.504; 95% CI, 0.281–0.905), and intentional inhalation (OR, 2.282; 95% CI, 1.659–3.139) were independently associated with ICU admission. Our study demonstrated that age, mental change, SBP, HR, SPO2, O2 supply, use of nasal prongs, and intentional inhalation in patients with CO poisoning were associated with their ICU admission.

Carbon monoxide poisoning can act as a stress test to reveal underlying coronary artery disease: case report

2020 ◽  
pp. 151-169
Author(s):  
Lindell K. Weaver ◽  
◽  
Keyword(s):  
Carbon Monoxide ◽  
Hyperbaric Oxygen ◽  
Carbon Monoxide Poisoning ◽  
Stress Test ◽  
The United States ◽  
Brain Inflammation ◽  
Smoke Inhalation ◽  
Co Poisoning ◽  
Exposure Limits ◽  
Disease Case

Despite established exposure limits and safety standards as well as the availability of carbon monoxide (CO) alarms, each year 50,000 people in the United States visit emergency departments for CO poisoning. Carbon monoxide poisoning can occur from brief exposures to high levels of CO or from longer exposures to lower levels. Common symptoms can include headaches, nausea and vomiting, dizziness, general malaise, and altered mental status. Some patients may have chest pain, shortness of breath, and myocardial ischemia, and may require mechanical ventilation and treatment of shock. Individuals poisoned by CO often develop brain injury manifested by neurological problems, including cognitive sequelae, anxiety and depression, persistent headaches, dizziness, sleep problems, motor weakness, vestibular and balance problems, gaze abnormalities, peripheral neuropathies, hearing loss, tinnitus, Parkinsonian-like syndrome, and other problems. In addition, some will have cardiac issues or other ailments. While breathing oxygen hastens the removal of carboxyhemoglobin (COHb), hyperbaric oxygen (HBO2) hastens COHb elimination and favorably modulates inflammatory processes instigated by CO poisoning, an effect not observed with breathing normobaric oxygen. Hyperbaric oxygen improves mitochondrial function, inhibits lipid peroxidation transiently, impairs leukocyte adhesion to injured microvasculature, and reduces brain inflammation caused by the CO-induced adduct formation of myelin basic protein. Based upon three supportive randomized clinical trials in humans and considerable evidence from animal studies, HBO2 should be considered for all cases of acute symptomatic CO poisoning. Hyperbaric oxygen is indicated for CO poisoning complicated by cyanide poisoning, often concomitantly with smoke inhalation.

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