Introduction
This topic covers acute toxic respiratory injuries: damage to the airways and lung tissue caused by a single inhalation or short exposure to a toxic gas, vapour, fume or smoke. It covers the causes and mechanisms of injury, the clinical picture, the diagnostic work-up, emergency treatment, discharge criteria and long-term follow-up. Systemic poisoning mechanisms are covered in the toxicokinetics topic, and the general intoxication principles in the treatment-methods topic.
Definition and causes
An acute toxic respiratory injury is harm to the airways and alveoli from an inhaled toxic substance, which may be accompanied by systemic effects. Exposure is most often occupational (industrial accidents, confined spaces, tank cleaning, welding, chemical plant leaks) but can also be environmental (house fires, indoor use of solvents, pool chemicals) or accidental in medical settings.
- Industrial chemicals and gases: chlorine, ammonia, sulphur dioxide, hydrogen chloride, nitrogen dioxide, phosgene, hydrogen sulphide.
- Fumes and smokes: thermal decomposition products of plastics, insulation and other materials in fires.
- Volatile organic compounds: solvents, hydrocarbons, paint thinners, degreasers, aerosols.
- Respiratory depressants: opioids, sedatives and other drugs that reduce ventilatory drive and cause hypoventilation.