Specific conditions Smoke inhalation

• Smoke rarely causes thermal injury beyond the level of bronchi as it has a low specific heat content. However, soot is a major irritant to the upper airways and can produce very rapid and marked inflammation.

• Urgent laryngoscopy should be performed if soot is present in the nares, mouth or pharynx.

• If soot is seen or the larynx appears inflamed, perform early endotracheal intubation. As the upper airway can obstruct within minutes it is advisable to intubate as a prophylactic measure rather than as an emergency where it may prove impossible.

• After intubation, perform urgent bronchoscopy with bronchial toilet using warmed 0.9% saline to remove as much soot as possible.

• Commence benzylpenicillin 1.2g qds IV.

• Specific treatment for poisons contained within smoke (e.g. carbon monoxide, cyanide)

Steam inhalation

• Consider early/prophylactic intubation

• Steam has a much higher heat content than smoke and can cause injury to the whole respiratory tract.

• Consider early bronchoscopy and lavage with cool 0.9% saline.

Aspiration of gastric contents

• Early bronchoscopy and physiotherapy to remove as much particulate and liquid matter as possible.

• Either cefuroxime plus metronidazole, or clindamycin for 3-5 days.

• Steroid therapy has no proven benefit.

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