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Various injury patterns due to combustion (typical but unfamiliar to physicians and easy to miss) in Korea: a case report

  • Hyung Il Kim (Department of Emergency Medicine, Dankook University Hospital, Dankook University College of Medicine)
  • Received : 2023.09.06
  • Accepted : 2023.09.17
  • Published : 2023.12.31

Abstract

Patients transported from fire sites may exhibit various injury patterns. Major trauma, skin burn, inhalation burn, and carbon monoxide poisoning are typical injuries. However, most physicians may be unfamiliar that cyanide poisoning can frequently occur due to combustion. Cyanide poisoning is highly significant owing to high mortality and the existence of antidotes. I present a 35-year-old man who was transported from a burning building and suffered severe metabolic acidosis despite no major bleeding as well as mild carbon monoxide poisoning. I suspected cyanide poisoning and administered the antidote; subsequently, the patient showed improvement. The next day, sudden airway obstruction developed, and emergency endotracheal intubation was performed. The inhalation damage was detected only in the lower airway tract and not in the upper airway. Physicians should be aware of cyanide poisoning and inhalation burn to avoid missing treatment opportunities.

Keywords

References

  1. Tursky T, Sajter V. The influence of potassium cyanide poisoning on the gamma-aminobutyric acid level in rat brain. J Neurochem 1962;9:519-23. https://doi.org/10.1111/j.1471-4159.1962.tb04205.x
  2. Mohan A, Lee T, Sachdev P. Surviving acute cyanide poisoning: a longitudinal neuropsychological investigation with interval MRI. BMJ Case Rep 2014;2014:bcr2013203025.
  3. Cummings TF. The treatment of cyanide poisoning. Occup Med (Lond) 2004;54:82-5. https://doi.org/10.1093/occmed/kqh020
  4. Hall AH, Linden CH, Kulig KW, Rumack BH. Cyanide poisoning from laetrile ingestion: role of nitrite therapy. Pediatrics 1986;78:269-72. https://doi.org/10.1542/peds.78.2.269
  5. O'Brien B, Quigg C, Leong T. Severe cyanide toxicity from 'vitamin supplements'. Eur J Emerg Med 2005;12:257-8. https://doi.org/10.1097/00063110-200510000-00014
  6. Huzar TF, George T, Cross JM. Carbon monoxide and cyanide toxicity: etiology, pathophysiology and treatment in inhalation injury. Expert Rev Respir Med 2013;7:159-70. https://doi.org/10.1586/ers.13.9
  7. Megarbane B, Delahaye A, Goldgran-Toledano D, Baud FJ. Antidotal treatment of cyanide poisoning. J Chin Med Assoc 2003;66:193-203.
  8. Walsh DW, Eckstein M. Hydrogen cyanide in fire smoke: an underappreciated threat. Emerg Med Serv 2004;33:160-3.
  9. Baud FJ, Barriot P, Toffis V, et al. Elevated blood cyanide concentrations in victims of smoke inhalation. N Engl J Med 1991;325:1761-6. https://doi.org/10.1056/NEJM199112193252502
  10. Dries DJ, Endorf FW. Inhalation injury: epidemiology, pathology, treatment strategies. Scand J Trauma Resusc Emerg Med 2013;21:31.
  11. Dumestre D, Nickerson D. Use of cyanide antidotes in burn patients with suspected inhalation injuries in North America: a cross-sectional survey. J Burn Care Res 2014;35:e112-7. https://doi.org/10.1097/BCR.0b013e31829b3868
  12. National Emergency Medical Center. Intoxication information system [Internet]. National Medical Center of Korea; [cited 2023 Aug 10]. Available from: https://erpoison.nemc.or.kr/introduction/poisIntrdct.do
  13. Fortin JL, Giocanti JP, Ruttimann M, Kowalski JJ. Prehospital administration of hydroxocobalamin for smoke inhalation-associated cyanide poisoning: 8 years of experience in the Paris Fire Brigade. Clin Toxicol (Phila) 2006;44 Suppl 1:37-44. https://doi.org/10.1080/15563650600811870
  14. Nichol G, Thomas E, Callaway CW, et al. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA 2008;300:1423-31. https://doi.org/10.1001/jama.300.12.1423
  15. McCall JE, Cahill TJ. Respiratory care of the burn patient. J Burn Care Rehabil 2005;26:200-6.
  16. Pruitt BA Jr, Flemma RJ, DiVincenti FC, Foley FD, Mason AD Jr, Young WG Jr. Pulmonary complications in burn patients: a comparative study of 697 patients. J Thorac Cardiovasc Surg 1970;59:7-20. https://doi.org/10.1016/S0022-5223(19)42510-5
  17. Endorf FW, Dries DJ. Noninvasive ventilation in the burned patient. J Burn Care Res 2010;31:217-28. https://doi.org/10.1097/BCR.0b013e3181d0f62c
  18. Endorf FW, Gamelli RL. Inhalation injury, pulmonary perturbations, and fluid resuscitation. J Burn Care Res 2007;28:80-3. https://doi.org/10.1097/BCR.0B013E31802C889F
  19. Fein A, Leff A, Hopewell PC. Pathophysiology and management of the complications resulting from fire and the inhaled products of combustion: review of the literature. Crit Care Med 1980;8:94-8. https://doi.org/10.1097/00003246-198002000-00008
  20. Herndon DN, Thompson PB, Traber DL. Pulmonary injury in burned patients. Crit Care Clin 1985;1:79-96. https://doi.org/10.1016/S0749-0704(18)30672-9
  21. Carr JA, Phillips BD, Bowling WM. The utility of bronchoscopy after inhalation injury complicated by pneumonia in burn patients: results from the National Burn Repository. J Burn Care Res 2009;30:967-74. https://doi.org/10.1097/BCR.0b013e3181bfb77b
  22. Arakawa A, Fukamizu H, Hashizume I, et al. Macroscopic and histological findings in the healing process of inhalation injury. Burns 2007;33:855-9. https://doi.org/10.1016/j.burns.2006.10.405
  23. Mosier MJ, Gamelli RL, Halerz MM, Silver G. Microbial contamination in burn patients undergoing urgent intubation as part of their early airway management. J Burn Care Res 2008;29:304-10. https://doi.org/10.1097/BCR.0b013e318166daa5