Smoke Inhalation Injury

Smoke inhalation represents a critical, multi-faceted injury involving thermal damage, asphyxiation, and delayed toxic lung complications. While the initial 24 to 48 hours often present as a deceptive "honeymoon period," severe pulmonary dysfunction frequently emerges thereafter due to the sloughing of epithelial cells and subsequent retrograde bronchorrhea. Asphyxiation from carbon monoxide and cyanide poisoning demands immediate attention, with carbon monoxide requiring co-oximetry for accurate diagnosis and cyanide necessitating rapid antidote administration like hydroxycobalamin. Standard pulse oximetry fails to detect carbon monoxide toxicity, and clinical findings like soot or clear lung sounds are unreliable indicators of injury severity. Effective management prioritizes elective airway control, the use of aerosolized racemic epinephrine to reduce edema, and advanced ventilation techniques such as high-frequency percussive ventilation to facilitate pulmonary toilet and secretion clearance in compromised patients.