1/6. Extracorporeal support in an adult with severe carbon monoxide poisoning and shock following smoke inhalation: a case report.The objective of this study was to discuss the case of a patient with severe smoke inhalation-related respiratory failure treated with extracorporeal support. The study was set in a 12-bed multi-trauma intensive care unit at a level one trauma center and hyperbaric medicine center. The patient under investigation had carbon monoxide poisoning, and developed acute respiratory distress syndrome and cardiovascular collapse following smoke inhalation. Rapid initiation of extracorporeal support, extreme inverse-ratio ventilation and intermittent prone positioning therapy were carried out. Admission and serial carboxyhemoglobin levels, blood gases, and computerized tomography of the chest were obtained. The patient developed severe hypoxia and progressed to cardiovascular collapse resistant to resuscitation and vasoactive infusions. Veno-venous extracorporeal support was initiated. Cardiovascular parameters of blood pressure, cardiac output, and oxygen delivery were maximized; oxygenation and ventilation were supported via the extracorporeal circuit. Airway pressure release ventilation and intermittent prone positioning therapy were instituted. Following 7 days of extracorporeal support, the patient was decannulated and subsequently discharged to a transitional care facility,neurologically intact. Smoke inhalation and carbon monoxide poisoning may lead to life-threatening hypoxemia associated with resultant cardiovascular instability. When oxygenation and ventilation cannot be achieved via maximal ventilatory management, extracorporeal support may prevent death if initiated rapidly.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/6. Acute pulmonary oedema following smoke inhalation.A case of acute pulmonary oedema after smoke inhalation from a chip pan fire is presented. The role of bronchial and pulmonary circulation in the development of pulmonary oedema after smoke inhalation is discussed. We stress the importance not only of observation after smoke inhalation, as the manifestation of pulmonary oedema may be delayed, but also of a baseline chest X-ray before admission for comparison.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
3/6. Computed tomography--a possible aid in the diagnosis of smoke inhalation injury?Inhalation injury is an important contributor to morbidity and mortality in burn victims and can trigger acute lung injury and acute respiratory distress syndrome (ARDS) (1-3). early diagnosis and treatment of inhalation injury are important, but a major problem in planning treatment and evaluating the prognosis has been the lack of consensus about diagnostic criteria (4). Chest radiographs on admission are often non-specific (5, 6), but indicators include indoor fires, facial burns, bronchoscopic findings of soot in the airways, and detection of carbon monoxide or cyanide in the blood (7). Changes in the lungs may be detected by bronchoscopy with biopsy, xenon imaging, or measurement of pulmonary extracellular fluid (4, 5, 8). These methods have, however, been associated with low sensitivity and specificity, as exemplified by the 50% predictive value in the study of Masanes et al. (8). Computed tomographs (CTs) are better than normal chest radiographs in the detection of other pulmonary lesions such as pulmonary contusion (9, 10). The importance of CT scans in patients with ARDS has been reviewed recently (9), but unfortunately there has been no experience of CT in patients with smoke inhalation injury. To our knowledge, there are only two animal studies reporting that smoke inhalation injury can be detected by CT (4, 11); specific changes in human CT scans have not yet been described. Therefore, confronted with a patient with severe respiratory failure after a burn who from the history and physical examination showed the classic risk factors for inhalation injury, we decided to request a CT.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
4/6. Long-term course of bronchiectasis and bronchiolitis obliterans as late complication of smoke inhalation.We describe the long-term course of a patient with bronchiectasis and bronchiolitis obliterans, both of which developed as late complications of a smoke inhalation injury. Sequential chest x-rays obtained during the observation period showed gradual progression of bronchiectasis from the saccular to the cystic type. Symptoms, spirometry and blood gas analysis, however, remained stable for 15 years. We believe that symptoms and physiological derangement were due mainly to bronchiolitis obliterans, and that once the pathophysiological condition had been established following the initial injury, it could be maintained by conservative medical management.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
5/6. Terrorist bombing with a 'Molotov cocktail' inside travelling cars: an old weapon for a new burn syndrome?The 'Molotov cocktail' terrorist weapon which is thrown into a travelling car has given a new type of injury to people who sustain massive smoke inhalation together with disfiguring burns of face, thighs, hands and chest, and post-traumatic psychological disorder. The combination of petrol ignition with the synthetic fumes inside the care is a unique occurrence with a high morbidity and mortality which is difficult to treat and to manage. We propose to show that the combination of all the above components can be defined as the 'Molotov cocktail' burn syndrome.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
6/6. Acute noncardiogenic pulmonary edema due to polymer fume fever.BACKGROUND: Certain fluorocarbon polymers can produce a clinical syndrome called polymer fume fever when the products of pyrolysis are inhaled. SUMMARY: A previously healthy 21-year-old white man presented with severe chest tightness, difficulty in breathing, pyrexia, nausea, vomiting, and a dry irritating cough. These symptoms occurred suddenly while smoking a cigarette 2 hours after leaving his place of work, where he is a plastics machinist. A chest roentgenogram revealed a bilateral patchy alveolar air space filling pattern involving the mid and lower lung fields. The diagnosis of polymer fume fever was established on the basis of the symptom complex, the association with cigarette smoking, and the occupational exposure to micronized polytetrafluoroethylene. CONCLUSIONS: A thorough occupational and smoking history is necessary to recognize polymer fume disease, which may resemble influenza.- - - - - - - - - - ranking = 2keywords = chest (Clic here for more details about this article) |