[Smoke poisoning].

Abstract

SYSTEMIC AND LOCAL EFFECT: Smoke inhalation causes systemic and local, mainly respiratory, toxicity due to the asphyxiant and irritant properties of toxic gases. OXYGEN DEPRIVATION AND INTOXICATION: The syndrome of oxygen deprivation and intoxication by asphyxiant gases is caused by combustion-induced oxygen deprivation and exposure to carbon monoxide (CO) and cyanide (CN), but also to other toxic gases. A loss of consciousness is a good sign of systemic toxicity; however, the respective role of CO, CN and other toxic gases cannot be determined. The presence of apnea, lactic acidosis, and severe cardiovascular disturbances is consistent with CN poisoning. A correlation exists between blood CO concentration determined on a sample obtained at the site of the fire, and the occurrence and severity of the clinical disorders. IRRITANT GASES INTOXICATION: This syndrome explains the mucosal injury affecting the eyes and the lungs. These complications are better diagnosed by clinical examination rather than by various investigations such as chest X-ray or fiberoptic bronchoscopy. Dysphonia is always a sign of severe poisoning. CLINICAL COURSE: In non-burned victims, delayed neurological and respiratory complications can be observed. Oxygen administration is the cornerstone supportive therapy. Hyperbaric oxygen should be discussed according to the severity of the syndrome of oxygen deprivation and intoxication by asphyxiant gases. In case of cyanide poisoning, a safe and effective antidote should be given; hydroxocobalamine seems to be the drug of choice. Supportive treatment is efficient to treat respiratory failure. Endotracheal intubation should be considered in patients exhibiting early dysphonia associated with dyspnea.