Smoke Inhalation – Part 2

Exams & X-Rays

A number of tests and procedures may be performed. Which tests are performed depends on the severity of the signs and symptoms and is at the discretion of the doctor.

  • Chest X-ray
    • If the patient has respiratory complaints such as persistent cough and shortness of breath, a chest X-ray should be done.
    • The initial chest X-ray may be normal despite significant signs and symptoms.
    • A repeat chest X-ray may be necessary during the observation period to determine if delayed lung injury is occurring.
  • Pulse oximetry
    • A light probe is typically attached to the finger, toe, or earlobe, to determine the amount of oxygen in the blood.
    • Pulse oximetry may be inaccurate if the patient has low blood pressure, and enough blood is not getting to parts of the body where the probe is attached.
  • Blood tests
    • Complete blood count: This test is done to determine if there are enough red blood cells to carry oxygen, enough white blood cells to fight infection, and enough platelets to ensure clotting can occur.
    • Chemistries (also called basic metabolic profile): This test reveals any changes of pH in the blood that may happen because of interference with oxygen diffusion, transport, or use. Serum electrolytes (sodium, potassium, and chloride) can also be monitored. Renal (kidney) function tests (creatinine and blood urea nitrogen) are also monitored.
    • Arterial blood gas: For people with significant respiratory distress, acute mental status changes, or shock, an arterial blood gas may be obtained. This test may help the doctor to determine the degree of oxygen shortage.
    • Carboxyhemoglobin and methemoglobin levels: These levels should be measured in all smoke inhalation victims with respiratory distress, altered mental status, low blood pressure, seizures, fainting, and blood pH changes. It is now routinely done in many hospitals whenever arterial blood gas is assessed.

Self Care At Home

Remove the person with smoke inhalation from the scene to a location with clean air.

Make sure that you are not putting yourself in danger before you attempt to pull someone from a smoke-filled environment. If you would be taking a serious risk to help the person, wait for trained professionals to arrive at the scene.

If necessary, CPR should be initiated by trained bystanders until emergency medical help arrives.

Medical Treatment

A number of treatments may be given for smoke inhalation.

  • Oxygen
    • Oxygen is the mainstay of treatment.
    • Oxygen may be applied with a nose tube, mask, or through a tube down the throat.
    • If the patient has signs and symptoms of upper airway problems (hoarseness), they will most likely be intubated. The doctor places a tube down the throat to keep the airway from closing due to swelling.
    • If the patient has respiratory distress or mental status changes, they may also be intubated to enable the staff help with breathing, to suction mucus, and keep the patient from choking on secretions.
  • Bronchoscopy
    • Bronchoscopy is procedure performed through a small scope to directly look at the degree of damage done to the airways and to allow for suctioning of secretions and debris.
    • Usually bronchoscopy is done through an endotracheal tube after the patient receives adequate sedation and pain relievers.
    • Bronchoscopy may be necessary if the patient has increasing respiratory failure, fails to demonstrate clinical improvement, or a segment of the lung remains collapsed.
  • Hyperbaric oxygenation (HBO)
    • If the patient has carbon monoxide poisoning, hyperbaric oxygenation may be considered.
    • Hyperbaric oxygenation is a treatment in which the patient is given oxygen in a compression chamber.
    • Some studies have demonstrated that hyperbaric oxygenation causes a reduction in symptoms of the nervous system, and if the patient has carbon monoxide poisoning, it may make recovery quicker.
    • The indications for and availability of this treatment vary depending on the institution and the region in which the patient is hospitalized.

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About the author: Joe Fiorilli