In today’s episode, we explore a tragic but educational case involving a 15-year-old girl who suffered severe inhalation injury following a house fire. While heroically rescuing her brother and his friend, she endured prolonged cardiac arrest and severe multi-organ dysfunction. We’ll focus on the pathophysiology, investigation, and management of inhalation injuries, including the critical role of recognizing carbon monoxide and cyanide poisoning in these complex cases.

Key Learning Points:

Exposure to house fire and prolonged cardiac arrest
Signs of inhalation injury and airway compromise
Pathophysiology of inhalation injuries and their impact on multiple organ systems
Management strategies for inhalation injury, including airway protection and ventilation
Differentiating carbon monoxide and cyanide poisoning in pediatric fire victims

Case Presentation

A 15-year-old previously healthy girl is brought to the Pediatric Intensive Care Unit (PICU) after experiencing cardiac arrest during a house fire. She was found unconscious by firefighters after a heroic rescue attempt where she saved her brother and his friend. Upon arrival at the hospital, she was unresponsive, intubated, and in severe cardiovascular distress with signs of multi-organ dysfunction.

Key findings include:

Soot deposits and superficial burns on extremities
Prolonged resuscitation (45 minutes of field CPR and 47 minutes of in-hospital CPR)
Cardiovascular compromise with PVCs, cool extremities, and delayed capillary refill
Metabolic acidosis, AKI, coagulopathy, transaminitis
Severe hypoxic-ischemic encephalopathy on EEG

These findings raise immediate concern for inhalation injury, which is the primary focus of today's discussion.

Pathophysiology of Inhalation Injury

When a patient is exposed to smoke and hot gases during a fire, inhalation injury results in significant damage to the respiratory system. Inhalation injury has three main components:

Upper airway involvement – Thermal injury can cause swelling and obstruction.
Chemical pneumonitis – Noxious chemicals like carbon monoxide and cyanide trigger inflammation in the lungs.

Inhalation Injury in the PICU

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