EpistemisTracheoesophageal pain due to smoke inhalation
Specialty: Respiratory.
Why it occurs
- Direct thermal injury and chemical burn of the mucosa of the larynx, trachea and main bronchi secondary to the inhalation of smoke, hot gases and volatile hydrocarbons in the context of structural fires (causes cellular necrosis, massive mucosal edema and epithelial desquamation, clinically manifested as continuous retrosternal burning pain that worsens drastically with coughing and breathing)
- Carbon monoxide and cyanide poisoning with local tissue hypoxia of the respiratory mucosa
- Destructive chemical tracheobronchitis due to inhalation of phosgene, chlorine or plastic industrial fumes.
Initial workup
Urgent analytical arterial blood gases measuring levels of carboxyhemoglobin (COHb) and lactate (suggestive of cyanide poisoning); Emergency diagnostic flexible bronchoscopy (to directly evaluate the extent of thermal damage, presence of erythema, ulceration or detachment of the tracheal mucosa); Serial chest x-ray.
red flags
Presence of carbonaceous sputum (with black soot particles), facial burns or singeing of nasal vibrissae, inspiratory stridor (a sign of imminent obstructive laryngeal edema), progressive dysphonia, mental confusion, or oxygen saturation less than 90% that is not normalized with a conventional oxygen mask.
Standard management
- 100% normobaric oxygen therapy — reservoir mask without rebreathing at 15 L/min to accelerate the elimination of carbon monoxide; helium-oxygen can be considered if obstruction exists
- Dexamethasone — 4-8 mg intravenously every 12 hours to mitigate acute inflammatory airway edema
- Nebulizations with 3% hypertonic saline solution to promote the clearance of cellular debris and soot.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Respiratory
- Listed causes
- 3
- Treatment options
- 3