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Problems for Discussion - 3 - Smoke Inhalation


1. List the three mechanisms leading to injury in smoke inhalation.
2. Define the following and give examples: simple asphyxiant, chemical asphyxiant, pulmonary irritant.
3. Give examples of combined irritant and asphyxiant properties.
4. List the sources of some of the more common toxic inhalants.
5. List factors increasing the risk of smoke inhalation injury.
6. Explain how water solubility of smoke particles can affect clinical presentation.
7. List the symptoms suggesting serious injury.
8. List the signs that must be excluded on physical exam to rule out significant injury to the respiratory tract.
9. Explain your management of the airway for a smoke inhalation victim.
10. Describe the role of beta agonists, steroids, adrenaline, NSAIDs, and mechanical ventilation in the management of seriously compromised airways.


  1. Reske A, Bak Z, Samuelsson A, Morales O, et al. Computed tomography - a possible aid in the diagnosis of smoke inhalation injury? Acta Anaesthesiol Scand. 2005;49:257-60.
  2. Thompson JT, Molnar JA, Hines MH, et al. Successful management of adult smoke inhalation with extracorporeal membrane oxygenation. J Burn Care Rehabil. 2005;26:62-6.
  3. Park GY, Park JW, Jeong DH, Jeong SH. Prolonged airway and systemic inflammatory reactions after smoke inhalation. Chest. 2003;123:475-80.
  4. Hantson P, Butera R, Clemessy J, et al. Early complications and value of initial clinical and paraclinical observations in victims of smoke inhalation without burns. Chest. 1997;111:671-675.
  5. Murakami K, Traber DL.Pathophysiological basis of smoke inhalation injury.News Physiol Sci. 2003 Jun;18:125-9.(fulltext)
  6. American Burn Association. Inhalation injury: diagnosis. J Am Coll Surg 2003;196:307-12.

Problem 1

A 50-year-old male, industrial worker presents to the Emergency Department 3 hours after being caught in a fire at work. He is coughing, complains of difficulty breathing. His O2 saturation is 95% on room air, heart rate 120/min, and RR of 36/min. His speech is normal and no stridor or hoarseness is evident. Auscultation reveals discrete wheezing in both lung fields.

  1. What investigations are required?
  2. How are you going to manage this patient?
  3. What will determine how long the patient remains in hospital for?

Problem 2

During Melbourne Grand Prix, a female motor racing fan managed to get passed the security zone for spectators and entered one of the pits. She stood under the racing cars as they were getting their engines tested and ready. She is found barely conscious by a mechanic and brought to your Emergency Department. Oxygen is administered in transit. On arrival she remains deeply unconscious.

  1. How are you going to manage this patient?
  2. How can you explain her lack of improvement with oxygen therapy?
  3. What toxin(s) needs to be suspected in this setting?
/home/wikitoxo/public_html/data/pages/wikitox/problems_for_discussion_3_smoke_inhalation.txt · Last modified: 2018/09/01 09:01 (external edit)