Smoke inhalation injury is roughly defined as the injury of the bronchial tree and the respiratory system developing as a result of inhalation of particulate matter (soot) and chemical or thermal irritants found in smoke and accounts for up to 10,000 deaths every year in the United States [1]. Some of the most important compounds responsible for this type of injury are carbon monoxide (CO), hydrogen cyanide (HCN), free oxygen radicals (reactive oxygen species, or ROS), sulfur dioxide (SO2), benzene and other aromatic hydrocarbons, as well as ammonia (NH3) [2] [3] [4]. Despite their increasing concentrations in the industrial setting and markedly higher occupational exposure, inhalation of smoke during fires is the predominant mode of smoke related injury, as extensive nasopharyngeal irritation promotes breathing through the mouth and subsequent introduction of large amounts of smoke directly into the bronchial tree [1]. The clinical presentation depends on the amount of smoke inhaled, the concentration of gasses found in the smoke, and the ability of the individual's respiratory tract to cope with chemical and thermal injury [1] [2]. In most cases, mucosal edema and irritation eventually result in stridor, hoarseness, dyspnea, hypoxia, and tachypnea, whereas accompanying burns on the face and surrounding area is quite common [1] [3]. The presence of soot in the nasopharynx and sputum has also been documented as an important finding [3]. Loss of consciousness and respiratory insufficiency are signs of life-threatening smoke inhalation injury, in which case rapid therapeutic measures (mainly in the form of cessation of exposure to smoke) are mandatory [3] [4] [5].

The need for rapid treatment necessitates a prompt clinical workup by the physician, but in order to gain sufficient evidence for a presumptive diagnosis, a detailed patient history, and a thorough physical examination must be performed. As many patients develop altered consciousness and confusion, a heterogeneous anamnesis (friends, relatives, or coworkers who were exposed together with the patient) can be of great help in identifying the circumstances that preceded the development of symptoms [4]. Furthermore, findings such as facial burns, soot in the nasopharynx and sputum, as well as voice changes are highly indicative signs of smoke inhalation injury, which is why the role of a proper physical exam must not be overlooked [1]. As soon as clinical suspicion is raised, both laboratory and imaging studies should be performed [3] [6]. A complete blood count (CBC), pulse oximetry, and arterial blood gas (ABG) analysis are vital for evaluating the status of tissue perfusion and oxygen content, whereas computed tomography (CT) of the thorax is the recommended imaging modality [1] [3] [4] [5]. Pulmonary function testing (spirometry), electrocardiography (ECG), and measurements of carboxyhemoglobin are also a part of the initial workup, but in order to make a definite diagnosis and establish the severity of smoke inhalation injury, fiberoptic bronchoscopy (FOP), although being an invasive procedure, is the gold standard [2] [6].

Treatment for smoke inhalation injury focuses on ensuring adequate oxygenation and ventilation. Patients may receive supplemental oxygen or be placed on a ventilator if breathing is severely impaired. Bronchodilators can help open airways, and corticosteroids may reduce inflammation. In cases of carbon monoxide or cyanide poisoning, specific antidotes like hyperbaric oxygen therapy or hydroxocobalamin may be administered.

The prognosis for smoke inhalation injury varies depending on the severity of the exposure and the patient's overall health. Mild cases may resolve with supportive care, while severe injuries can lead to long-term respiratory issues or even be life-threatening. Early intervention and appropriate treatment significantly improve outcomes.

Smoke inhalation injury is primarily caused by exposure to smoke from fires. The smoke contains a mixture of harmful substances, including carbon monoxide, cyanide, and particulate matter, which can damage the respiratory tract and other organs. The risk is higher in enclosed spaces where smoke concentration is greater.

Smoke inhalation injuries are common in fire-related incidents, affecting both civilians and firefighters. They account for a significant number of fire-related deaths and injuries. The incidence is higher in urban areas with dense populations and in regions with frequent wildfires.

The pathophysiology of smoke inhalation injury involves both thermal and chemical damage. Heat from the smoke can cause burns to the upper airway, while toxic chemicals can lead to inflammation, edema, and impaired gas exchange in the lungs. Carbon monoxide binds to hemoglobin, reducing oxygen delivery to tissues, and cyanide disrupts cellular respiration.

Preventing smoke inhalation injury involves fire safety measures such as installing smoke detectors, having fire extinguishers readily available, and creating evacuation plans. Educating the public on fire safety and ensuring buildings comply with fire codes can reduce the risk of exposure.

Smoke inhalation injury is a serious condition resulting from exposure to harmful smoke. It can cause significant respiratory and systemic effects, requiring prompt medical evaluation and treatment. Understanding the symptoms, diagnostic process, and treatment options is crucial for managing this condition effectively.

If you suspect smoke inhalation injury, it is important to seek medical attention immediately. Symptoms like difficulty breathing, coughing, and confusion should not be ignored. Treatment focuses on ensuring you receive enough oxygen and addressing any toxic exposures. Following fire safety guidelines can help prevent such injuries.

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6. Demling RH. Smoke Inhalation Lung Injury: An Update. Eplasty. 2008;8:e27.