Bases del manejo clínico de la intoxicación por humo de incendios «Docohumo Madrid 2010»

Abstract

Poisoning by smoke is the main cause of morbidity and mortality in fires. Smoke is a mixture of carbonaceous particles suspended in hot air and toxic gases. Of these, carbon monoxide (CO) and primarily hydrocyanic acid (CNH), are those that provoke tissue anoxia. The clinical manifestations of smoke poisoning are variables. Some of the potential manifestations could be: eye irritation, sore throat, laryngeal stridor, dysphagia, carbonaceous sputum, cough, dyspnea, laryngospasm, bronchospasm, coronary syndrome, coma, hypoxemia, lactic acidosis, cyanosis and death. In the assessment of these patients the presence of soot in the nose, mouth or sputum suggests serious poisoning. Lactate levels higher than 10mmol/L indicates levels of cyanide major than 40micromole/L. The pulse co-oximetry has assumed an important step forward for the diagnosis, appraisal and monitoring of these patients. In the treatment it will be essential to assess the need of an early intubation. The administration of oxygen to the 100% will be essential. As an antidote to the cyanide, the first-choice is the hydroxocobalamin. Its administration has to be early. Its administration criteria are: patient who has inhaled smoke (remnants of soot in the mouth, pharynx or sputum) and has neurological disorder (confusion, coma, agitation, seizures) and also presents one of the following circumstances: bradypnea, respiratory arrest, cardiorespiratory arrest, shock, hypotension, lactate ≥8mmol/L or lactic acidosis. Logically, the rest of the management will be conventional depending on symptoms or complications.

Clinical features and predictors of delayed neurological syndrome in carbon monoxide poisoning: the AMICO study

“…Sólo se incluyeron casos de intoxicación por CO puro. Se excluyeron aquellos intoxicados por humo de incendio, al considerarse que en este supuesto durante el episodio de intoxicación estaban implicados otros tóxicos como el cianuro 19 .…”

Effectiveness of Hyperbaric Oxygenation Versus Normobaric Oxygenation Therapy in Carbon Monoxide Poisoning: A Systematic Review

“…Vomero et al analyzed three clinical cases of CO poisoning, in which the three patients were found unconscious; they mentioned that HBO must be applied under certain criteria such as loss of consciousness, neurological disturbance or coma [39]. This being the case, the patient must be transferred safely and hemodynamically stable [40,41]. A prospective trial demonstrated that the incidence of cognitive sequelae was lower in patients who underwent three HBO sessions within 24 hours after COP compared with patients treated with NBO [8,33].…”

Estudio de una década de intoxicaciones infantiles en un hospital terciario

“…En un estudio realizado en el 2001, durante 18 meses en los dos hospitales de Valladolid, se diagnosticaron 158 intoxicaciones por monóxido de carbono (Dueñas Laita)48 En nuestro estudio, las intoxicaciones por monóxido de carbono, constituyen la tercera causa de intoxicaciones en menores de edad. La edad media de dicha intoxicación es de 9,6 +/-5 años.En este tipo de intoxicaciones, muchas veces los pacientes acuden a los centros sanitarios asintomáticos; por ello, la coximetría debería ser solicitada a los familiares que hayan estado expuestos a la fuente de CO, cuando se confirma el diagnóstico en alguno de los miembros de la familia 156. (recogido en Docohumo 2010, Dueñas Laita) De hecho, si observamos los síntomas iniciales que presentan los pacientes en nuestro estudio, un 16,6% de los intoxicados acuden asintomáticos al servicio de urgencias hospitalario, y un 10,4% son menores de edad trasladados por haber encontrado una intoxicación por monóxido de carbono en los familiares que les acompañaban.…”