Algorithm for managing injury from smoke inhalation.

Abstract

BrMedJ 1989;299:902-5 Thermal injury accounts for 14 000 casualties a year in the United Kingdom. With improvements in managing cutaneous burns mortality has steadily reduced so that inhalational injury from smoke and hot, toxic gases is increasingly important in outcome.'1 When overlooked, smoke inhalation can lead to early or late deterioration in the patient's condition due to damage to the airways or lungs. In addition, poisoning may occur by inhalation of gases such as hydrogen cyanide or carbon monoxide. These problems were experienced in the fire at King's Cross in 1987, in which a fifth of the victims were found at postmortem examination to have high concentrations of carboxyhaemoglobin. Furthermore, despite controversy over the forensic method used there was evidence that cyanide poisoning may have had a contributory role in some of the deaths. In this unusual fire, however, the heat blast led rapidly to asphyxiation, thus reducing the duration of exposure to toxic inhalation. This disaster, supported by previous experience with inhalational burns in this unit, suggested the need for a protocol to guide clinicians in the early management of these patients. We have proposed an immediate care plan in the form of an algorithm. This aims to promote early recognition and treatment of the airway problems and the poisoning that result from